Wells Kristen J, Winters Paul C, Jean-Pierre Pascal, Warren-Mears Victoria, Post Douglas, Van Duyn Mary Ann S, Fiscella Kevin, Darnell Julie, Freund Karen M
Department of Psychology, San Diego State University and University of California, San Diego Moores Cancer Center, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120-1863, USA.
Family Medicine Research Programs, University of Rochester Medical Center, 1381 South Avenue, Rochester, NY, 14620, USA.
Support Care Cancer. 2016 Apr;24(4):1729-53. doi: 10.1007/s00520-015-2946-8. Epub 2015 Oct 5.
Despite growing popularity of patient navigation (PN) as a means to improve cancer care quality and reduce cancer-related disparities, there are few well-designed controlled trials assessing the impact of PN on patient outcomes like satisfaction with care. The present controlled study examined effect of PN on satisfaction with cancer-related care.
Patients who presented with a symptom or abnormal screening test (n = 1788) or definitive diagnosis (n = 445) of breast, cervical, colorectal, or prostate cancer from eight Patient Navigator Research Program sites were included in one of two groups: intervention (PN) or comparison (usual care or usual care plus cancer educational materials). Trained patient navigators met with intervention group participants to help them assess and identify resources to address barriers to cancer diagnostic or treatment care. Using a validated instrument, we assessed participants' satisfaction with their cancer diagnostic or treatment care up to 3 months after diagnostic resolution of a cancer-related abnormality or within 3 months of initiation of cancer treatment.
Overall, patients reported high satisfaction with diagnostic care and cancer treatment. There were no statistically significant differences between PN and control groups in satisfaction with cancer-related care (p > 0.05). Hispanic and African American participants were less likely to report high satisfaction with cancer care when compared to White patients. Middle-aged participants with higher education, higher household income, private insurance, owning their own home, working full-time, and those whose primary language is English had higher satisfaction with cancer-related diagnostic care.
PN had no statistically significant effect on patients' satisfaction with cancer-related care. Further research is needed to define the patient populations who might benefit from PN, content of PN that is most useful, and services that might enhance PN.
clinicaltrials.gov identifiers: NCT00613275 , NCT00496678 , NCT00375024 , NCT01569672.
尽管患者导航（PN）作为提高癌症护理质量和减少癌症相关差异的一种手段越来越受欢迎，但很少有设计良好的对照试验评估PN对患者护理满意度等结局的影响。本对照研究考察了PN对癌症相关护理满意度的影响。
来自八个患者导航研究项目站点的出现症状或筛查试验异常（n = 1788）或确诊（n = 445）乳腺癌、宫颈癌、结直肠癌或前列腺癌的患者被纳入两组之一：干预组（PN）或对照组（常规护理或常规护理加癌症教育材料）。经过培训的患者导航员与干预组参与者会面，帮助他们评估并确定资源，以解决癌症诊断或治疗护理的障碍。我们使用经过验证的工具，在癌症相关异常诊断解决后长达3个月或癌症治疗开始后3个月内，评估参与者对癌症诊断或治疗护理的满意度。
总体而言，患者对诊断护理和癌症治疗的满意度较高。PN组和对照组在癌症相关护理满意度方面无统计学显著差异（p > 0.05）。与白人患者相比，西班牙裔和非裔美国参与者对癌症护理报告高满意度的可能性较小。受过高等教育、家庭收入较高、有私人保险、拥有自己的住房、全职工作且主要语言为英语的中年参与者对癌症相关诊断护理的满意度较高。
PN对患者对癌症相关护理的满意度无统计学显著影响。需要进一步研究来确定可能从PN中受益的患者群体、最有用的PN内容以及可能增强PN的服务。
clinicaltrials.gov标识符：NCT00613275、NCT00496678、NCT00375024、NCT01569672。
