Barriers reported among patients with breast and cervical abnormalities in the patient navigation research program: impact on timely care

Womens Health Issues. Jan-Feb 2014;24(1):e155-62. doi: 10.1016/j.whi.2013.10.010.


Background: Patient navigation (PN) is a system-level strategy to decrease cancer mortality rates by reducing barriers to cancer care. Barriers to resolution among participants in the PN intervention arm with a breast or cervical abnormality in the Patient Navigation Research Program and navigators' actions to address those barriers were examined.

Methods: Data from seven institutions (2005-2010) included 1,995 breast and 1,194 cervical patients. A stratified Cox proportional hazards regression model was used to examine the effects of barriers on time to resolution of an abnormal screening test or clinical finding.

Findings: The range of unique barriers was 0 to 12 and 0 to 7 among participants with breast and cervical abnormalities, respectively. About two thirds of breast and one half of cervical participants had at least one barrier resulting in longer time to diagnostic resolution among breast (adjusted hazard ratio [HR], 0.744; p < .001) and cervical (adjusted HR, 0.792; p < .001) participants. Patient- and system-level barriers were most common. Frequent navigator actions were making arrangements, scheduling appointments, referrals, and education.

Conclusions: Having a barrier resulted in a delay in diagnostic resolution of an abnormal screening test or clinical finding. Health care systems can use these findings to improve existing PN programs or when developing new programs.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Attitude to Health
  • Breast Neoplasms / diagnosis*
  • Early Detection of Cancer*
  • Female
  • Health Services Accessibility
  • Healthcare Disparities
  • Humans
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Patient Navigation*
  • Proportional Hazards Models
  • Social Support
  • Socioeconomic Factors
  • Time Factors
  • United States
  • Uterine Cervical Neoplasms / diagnosis*
  • Young Adult