Healthcare reform: Continuing the prostate screening debate; Where does patient navigation belong?

Background: Prostate cancer is the most commonly diagnosed cancer and second leading cause of cancer death in the US among men. Although overall incidence and mortality has decreased over time, disparities still exists among racial groups. Strategies to reduce disparities in cancer detection, treatment, and outcomes among racial/ethnic minorities and low-income patients have been gathering momentum with the introduction of patient navigation (PN) initiatives. Research suggests that African American males rely on their physicians to recommend all needed tests/screenings. The study examined the current and potential roles of PN in the improvement of prostate screenings among disadvantaged populations (DP). Methods: Longitudinal study design was conducted on males over 35 years of age presenting to PN since 2008 (n=1602). Information included patient's demographics, geographical location, PSA scores, DRE scores, and the array of event types in which community engagement occurred. Data were analyzed using comparison analyses. Results: PN allowed for greater utilization of health services among populations of rural origins (Urban:n=747, Rural:n=833). Non-whites residing in rural areas mean PSA score was slightly higher than non-whites in urban areas of the state (Urban:1.36ng/mL, Rural:1.45ng/mL; p=0.03). Conclusions: Equity of access to cancer screenings among DP can be achieved with the utilization of PN programs. Access to the health care system is a strong barrier which fosters disparities among disadvantaged populations. PN allows rural disadvantaged populations entry into the health care system at earlier stages, considering PSA as a proxy for disease. Health care reform lays the foundation for preventative programs such as PN.