Tailoring navigation services : Why we need to think outside the box

The Centers for Medicare and Medicaid Services funded a national demonstration evaluating the efficacy of patient navigation services for minority adults receiving Medicare insurance (Parts A and B).

Purpose:

To describe barriers to cancer screening at baseline for urban African Americans, age 65+, who were randomized to receive cancer screening navigation services through a community academic partnership in Baltimore City.

Methods:

Participants in a randomized controlled trial received a face-to-face baseline interview on health status, healthcare utilization, latest date of cancer screening, and barriers to cancer screening. The participants were randomized to receive educational materials only, or, in addition, a patient navigator. Trained and certified navigators guide and support participants to receive timely breast, cervix, colorectal and prostate cancer screening, and if necessary, follow- up care. The primary role of navigators is to educate, motivate, reduce obstacles (e.g. appointment scheduling, transportation, insurance coverage), and link participants with community and non-cancer related services.

Results:

Of 1475 individuals enrolled into this trial, 738 who were randomized to screening navigation services. Among the navigated participants, 26% are male, 33% have less than a high school diploma, 66% are <75 years of age, 45% have <$0,000 annual household income. The primary reported reason for failure to receive all age-appropriate cancer screenings is: “Doctor didn't tell me I needed it”; Navigation services have been provided to 672.

Conclusions:

Navigation services need to be comprehensive, including addressing provider, health care system and human service needs as identified by participants as priority areas of concern.