A clinical trial conducted by Massachusetts General Hospital (MGH) investigators has found that the use of patient navigators - individuals who assist patients in receiving health care services - may improve comprehensive cancer screening rates among patient populations not likely to receive recommended screenings. The study, which received Online First publication earlier this month in JAMA Internal Medicine, found that such patients - mostly low-income and ethnic minorities - were more likely to adhere to cancer-screening guidelines when assisted by patient navigators.
"These findings demonstrate how effective patient navigators can be for patients who, for a variety of reasons, encounter obstacles to receiving cancer screening," says Sanja Percac-Lima, MD, PhD, physician leader for cancer outreach at the MGH Center for Community Health Improvement and the study's lead author. "Health disparities pose a major challenge to low-income and ethnic minority patients, and our study suggests a proactive approach may help increase their chances of receiving the care they need."
Using a computer system, researchers identified patients across 18 MGH primary care practices, including four community health centers, who were at-risk of not completing recommended cancer screenings - based on a previous missed appointment and their primary language not being English - and who were also overdue for breast, cervical, and/or colorectal cancer screening. Among 1,626 identified at-risk patients, 792 were randomly assigned a patient navigator who would provide intense outreach and guidance to assist in obtaining screenings. Navigators contacted patients in their own language, educated and encouraged them, arranged transportation and accompanied them to visits, and helped overcome any other barriers to obtaining screening. The study results showed that 32 percent of patients who were successfully connected with patient navigators completed at least one overdue cancer screening, compared with 18 percent of patients in the control group.
"Patient navigators provide a critical bridge between patients and caregivers that enhances and improves care," says Percac-Lima, who is an assistant professor of Medicine at Harvard Medical School. "By employing these types of tactics, we can address critical health disparities for at-risk communities."
The co-authors of the JAMA Internal Medicine paper are Jeffrey M. Ashburner PhD, MPH, Yuchiao Chang, PhD, and senior author Steven J. Atlas, MD, MPH, of the MGH Division of General Internal Medicine; Sarah A. Oo, MSW, and Erica Guimaraes, of the MGH Chelsea Healthcare Center; and Adrian H. Zai, MD, MPH, PhD, of the MGH Laboratory of Computer Science.
The study was funded by American Cancer Society Cancer Control Career Development Award for Primary Care Physicians CCCDAA-14-012-01-CCCDA, the Lazarex Cancer Foundation, and the Harvard Medical School Center for Primary Care Innovation Fellowship.
Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $800 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. The MGH topped the 2015 Nature Index list of health care organizations publishing in leading scientific journals, earned the prestigious 2015 Foster G. McGaw Prize for Excellence in Community Service and returned to the number one spot on the 2015-16 U.S. News & World Report list of "America's Best Hospitals."