Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.
Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
J Gen Intern Med. 2020 Oct;35(10):3026-3035. doi: 10.1007/s11606-020-06020-9. Epub 2020 Jul 22.
This study evaluates the effectiveness of patient navigation to increase screening for colorectal, breast, and cervical cancer in populations adversely affected by health care disparities.
Eligible studies were identified through English-language searches of Ovid® MEDLINE®, PsycINFO®, SocINDEX, and Veterans Affairs Health Services database (January 1, 1996, to July 5, 2019) and manual review of reference lists. Randomized trials and observational studies of relevant populations that evaluated the effectiveness of patient navigation on screening rates for colorectal, breast, or cervical cancer compared with usual or alternative care comparison groups were included. Two investigators independently abstracted study data and assessed study quality and applicability using criteria adapted from the U.S. Preventive Services Task Force. Discrepancies were resolved by consensus with a third reviewer. Results were combined using profile likelihood random effects models.
Thirty-seven studies met inclusion criteria (28 colorectal, 11 breast, 4 cervical cancers including 3 trials with multiple cancer types). Screening rates were higher with patient navigation for colorectal cancer overall (risk ratio [RR] 1.64; 95% confidence interval [CI] 1.42 to 1.92; I = 93.7%; 22 trials) and by type of test (fecal occult blood or immunohistochemistry testing [RR 1.69; 95% CI 1.33 to 2.15; I = 80.5%; 6 trials]; colonoscopy/endoscopy [RR 2.08; 95% CI 1.08 to 4.56; I = 94.6%; 6 trials]). Screening was also higher with navigation for breast cancer (RR 1.50; 95% CI 1.22 to 1.91; I = 98.6%; 10 trials) and cervical cancer (RR 1.11; 95% CI 1.05 to 1.19; based on the largest trial). The high heterogeneity of cervical cancer studies prohibited meta-analysis. Results were similar for colorectal and breast cancer regardless of prior adherence to screening guidelines, follow-up time, and study quality.
In populations adversely affected by disparities, colorectal, breast, and cervical cancer screening rates were higher in patients provided navigation services. Registration: PROSPERO: CRD42018109263.
本研究评估了患者导航在增加受医疗保健差异不利影响的人群的结直肠癌、乳腺癌和宫颈癌筛查方面的有效性。
通过对 Ovid® MEDLINE®、PsycINFO®、SocINDEX 和退伍军人事务健康服务数据库（1996 年 1 月 1 日至 2019 年 7 月 5 日）进行英语搜索，并对参考文献进行手工审查，确定了符合条件的研究。纳入了对相关人群进行的患者导航对结直肠癌、乳腺癌或宫颈癌筛查率的有效性的随机试验和观察性研究，与常规或替代护理对照组进行比较。两名调查员独立提取研究数据，并使用美国预防服务工作组的标准评估研究质量和适用性。分歧通过与第三位评审员协商解决。结果采用似然比随机效应模型进行合并。
37 项研究符合纳入标准（28 项结直肠癌、11 项乳腺癌、4 项宫颈癌，包括 3 项具有多种癌症类型的试验）。患者导航对结直肠癌的总体筛查率更高（风险比 [RR] 1.64；95%置信区间 [CI] 1.42 至 1.92；I = 93.7%；22 项试验）和通过测试类型（粪便潜血或免疫组织化学检测 [RR 1.69；95%CI 1.33 至 2.15；I = 80.5%；6 项试验]；结肠镜检查/内窥镜检查 [RR 2.08；95%CI 1.08 至 4.56；I = 94.6%；6 项试验]）。导航对乳腺癌（RR 1.50；95%CI 1.22 至 1.91；I = 98.6%；10 项试验）和宫颈癌（RR 1.11；95%CI 1.05 至 1.19；基于最大的试验）的筛查率也更高。宫颈癌研究的高度异质性使得无法进行荟萃分析。无论患者是否先前遵守筛查指南、随访时间和研究质量如何，结直肠癌和乳腺癌的结果都相似。
在受差异不利影响的人群中，提供导航服务的患者的结直肠癌、乳腺癌和宫颈癌筛查率更高。注册：PROSPERO：CRD42018109263。
