District of Columbia City-wide Patient Navigator Research Program (DC-PNRP)

One of 9 U.S. sites included in NCI/ACS national research program evaluating efficacy of patient navigation in reducing cancer disparities. Patient navigation includes reduction of barriers to obtaining needed health care and addressing cultural/psychological factors. DC-PNRP evaluates effectiveness of navigation compared to “usual care” in decreasing time from suspicious breast finding to diagnostic resolution, time from diagnosis to breast cancer treatment initiation, and in providing most cost-effective strategy (costs per quality-adjusted-year-of-life saved), with additional evaluation of factors mediating the intervention's effects. Enrollment initiated at point of abnormal screen and expected to amount to 2000 women with minorities targeted at all 6 participating DC sites. Five-year timeline: Year 1= development; Years 2–4= data collection to begin January 2007; Year 5= analysis. A complex infrastructure established with tailored site-specific SOPs that provide for common data collection, along with communication links to assure adherence to protocol. Local area training conducted to supplement national. Intricate national system developed to assure agreement on data elements across U.S. sites. Due to breast cancer mortality rates for minorities in DC being among the Nation's highest with significant differential compared to whites, and existence of evidence suggesting cause is late stage at diagnosis and/or non-adherence to treatment regime, our city-wide patient navigation program was designed to impact this disparity by providing minority women assistance in navigating the health care system. Existence of well-established Cancer Consortium in DC, plus commitment of city's major medical centers to reducing cancer disparities, suggests our program will be sustainable and successful.