Abstract
Background: Patient navigation has become an important component of quality cancer care, especially for underserved populations. Research is needed to learn about how these programs address psychosocial issues and to determine the feasibility of these programs in underserved populations. This demonstration project involved the implementation of a theory-driven patient navigation program in an urban healthcare setting.
Methods: Newly diagnosed cancer patients were recruited and followed to assess their satisfaction, the impact on affect measures (patient's perceptions on stress-related thoughts), intrusive thoughts and avoidance issues (Revised Impact of Events Scale - RIES). Relying on community-based participatory research, a “lay” navigator model was used to address patient issues (process and/or psychosocial) and to demonstrate a change in these measures. After enrollment and giving consent, a baseline survey was administered to the patients. Two follow-up assessments were also administered at four and twelve weeks after the baseline assessment to determine the impact. Patient satisfaction was the only measure not included in the baseline assessment (four and twelve weeks only). Paired t-tests were used to determine the significance of change in satisfaction, affect scores, and the RIES scores. A linear model was used to determine the correlation between the affect score at baseline (predictor) and patient satisfaction at four weeks (outcome). Significance was determined at the 0.05 level.
Results: A total of 44 patients enrolled, consented and completed the baseline assessment. Approximately 63% of the patients recruited were in the low-income category (< $15,000 annually) and nearly 82% were women. The mean patient satisfaction score significantly increased from 4 to 12 weeks after entering the study (P = 0.029). The mean affect score significantly decreased from baseline to 4 weeks (P < 0.001) and from baseline to 12 weeks (P < 0.001). There was no significant change in the RIES score from baseline to 4 weeks but the mean RIES score significantly decreased from 4 to 12 weeks (P = 0.019). Results from the linear model showed a strong, positive correlation between the affect score at baseline and patient satisfaction at 4 weeks (Beta = 0.597, t = 2.997, 95% CI: 0.195 − 0.999, P = 0.005).
Conclusions: The results of the demonstration project suggest a positive impact on patient satisfaction and reducing the psychosocial impact on the patient regarding their cancer diagnosis. The results also suggest a possible impact of psychosocial variables on patient satisfaction. Future navigation interventions and programs should consider the psychosocial impact of cancer on patients and tailor these accordingly.
Second AACR International Conference on the Science of Cancer Health Disparities— Feb 3–6, 2009; Carefree, AZ