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Open Access Study protocol

Design of a prostate cancer patient navigation intervention for a Veterans Affairs hospital

Narissa J Nonzee12, June M McKoy134, Alfred W Rademaker14, Peter Byer1, Thanh Ha Luu5, Dachao Liu14, Elizabeth A Richey6, Athena T Samaras5, Genna Panucci7, XinQi Dong8 and Melissa A Simon145*

Author Affiliations

1 Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA

2 Jesse Brown VA Medical Center, Chicago, IL, USA

3 Department of Medicine, Division of General Internal Medicine & Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

4 Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

5 Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA

6 Dartmouth College, Geisel School of Medicine, Hanover, NH, USA

7 Harvard School of Public Health, Boston, MA, USA

8 Rush University Institute for Healthy Aging, Chicago, IL, USA

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BMC Health Services Research 2012, 12:340  doi:10.1186/1472-6963-12-340

Published: 25 September 2012

Abstract

Background

Patient navigation programs have been launched nationwide in an attempt to reduce racial/ethnic and socio-demographic disparities in cancer care, but few have evaluated outcomes in the prostate cancer setting. The National Cancer Institute-funded Chicago Patient Navigation Research Program (C-PNRP) aims to implement and evaluate the efficacy of a patient navigation intervention for predominantly low-income minority patients with an abnormal prostate cancer screening test at a Veterans Affairs (VA) hospital in Chicago.

Methods/Design

From 2006 through 2010, C-PNRP implemented a quasi-experimental intervention whereby trained social worker and lay health navigators worked with veterans with an abnormal prostate screen to proactively identify and resolve personal and systems barriers to care. Men were enrolled at a VA urology clinic and were selected to receive navigated versus usual care based on clinic day. Patient navigators performed activities to facilitate timely follow-up such as appointment reminders, transportation coordination, cancer education, scheduling assistance, and social support as needed. Primary outcome measures included time (days) from abnormal screening to diagnosis and time from diagnosis to treatment initiation. Secondary outcomes included psychosocial and demographic predictors of non-compliance and patient satisfaction. Dates of screening, follow-up visits, and treatment were obtained through chart audit, and questionnaires were administered at baseline, after diagnosis, and after treatment initiation. At the VA, 546 patients were enrolled in the study (245 in the navigated arm, 245 in the records-based control arm, and 56 in a subsample of surveyed control subjects).

Discussion

Given increasing concerns about balancing better health outcomes with lower costs, careful examination of interventions aimed at reducing healthcare disparities attain critical importance. While analysis of the C-PNRP data is underway, the design of this patient navigation intervention will inform other patient navigation programs addressing strategies to improve prostate cancer outcomes among vulnerable populations.

Keywords:
Patient navigation; Prostate cancer; Cancer health disparities; Veterans