Culturally competent patient navigation in the prevention of cervical cancer in underserved Hispanic women: The San Antonio Experience

Prevention of cervical cancer in underserved Hispanic women is compromised by many barriers to appropriate preventive care. To address these barriers, the National Cancer Institute organized the Patient Navigation Research Project (PNRP). Patient Navigation is a new paradigm of patient management where clinic personnel (e.g. public health nurse, health care educator, social worker, or other health care professional) guide underserved patients through a complex health care system so that individual patients obtain timely care from positive screening to definitive treatment. We have instituted a patient navigation program where we are comparing the effectiveness of public health nurses and community health educators in navigating patients through the San Antonio city and Bexar County health systems. Also, promotoras, or lay health educators, address the cultural needs of the patient, assist with tracking of patients, and ensure that patients make scheduled appointments. Women with positive Pap smears for cervical dysplasia when referred for colposcopy are enrolled in the PNRP and navigated from referral until definitive therapy is completed. Primary outcome variables are time from positive screen to definitive diagnosis, time from definitive diagnosis until treatment, and then to completed resolution. Patients lost to follow up are identified and efforts made to ensure that they continue their management plan. To date, 20 women have been enrolled, and updated data will be presented regarding their primary outcomes variables, as well as barriers to health care. Patient navigation holds promise of being a useful approach to ensure underserved women remain engaged in the health care system.