Patient Navigation Research Program (PNRP)
Active Date: 2005-2010
NCI addressed unequal patterns of standard health care access through CRCHD’s multisite Patient Navigation Research Program (PNRP). The PNRP focused on developing and testing interventions for follow-up and treatment initiation of four cancers with significant disparity: breast, cervical, prostate, and colorectal.
Although anyone could benefit from patient navigation services, the primary participants for this research program were populations experiencing cancer health disparities. These encompass racial/ethnic minorities, individuals with lower socioeconomic status, and residents of rural areas across the U.S.
PNRP grantees conducted formal qualitative and quantitative program evaluations to measure efficacy and cost-effectiveness of interventions and made recommendations for improving access to health care among health disparity populations.
- In October 2005, the NCI with support from the American Cancer Society, awarded nine five-year Cooperative Agreement research grants to academic research institutions to develop innovative patient navigation interventions to reduce or eliminate cancer health disparities and test their efficacy and cost effectiveness.
- CRCHD developed PNRP projects to reach patients in communities that experienced disproportionate shares of the cancer burden, including African Americans, American Indians, Asian Americans, Hispanics/Latinos, lower socioeconomic populations, and rural underserved populations.
- PNRP focused on four cancers for which there were low rates in screening and follow-up care: breast, cervical, prostate, and colorectal.
About Patient Navigators
Patient navigators are trained culturally sensitive health care workers who provide support and guidance to patients across the cancer care continuum. The most important role of patient navigators is to ensure that individuals with suspicious cancer findings receive timely diagnosis and treatment. Patient navigators help to:
- Coordinate appointments with doctors' offices, clinics, hospitals, outpatient centers, insurance and payment systems, patient-support organizations, and other components of the health care system.
- Maintain communication with patients, survivors, families, and health care providers, and monitor patient satisfaction with the cancer care experience.
- Ensure appropriate medical records are available at scheduled appointments.
- Arrange language translation or interpretation services.
- Facilitate financial support and helping with paperwork.
- Arrange transportation and/or child or elder care.
- Conduct community outreach, provide access to clinical trials, and build partnerships with local agencies and groups (e.g., referrals to other services and/or cancer survivor support groups).
- Develop innovative patient navigation interventions to reduce or eliminate cancer health disparities and test their efficacy and cost effectiveness.
- Design patient navigation interventions to decrease the time between a cancer-related abnormal finding, definitive diagnosis, and delivery of quality standard cancer care services.
The PNRP addressed four research questions:
- Does patient navigation reduce the time from an abnormal cancer screening finding to definitive diagnosis in patients with one of four screenable cancers: breast, cervix, colorectal, prostate?
- Does patient navigation reduce the time from cancer diagnosis to initiation of treatment and completion of treatment in patients with one of four cancers: breast, cervix, colorectal, prostate?
- Does patient navigation increase patients’ satisfaction with the health care system and, specifically, cancer-related care?
- Is patient navigation cost effective?
- Patient navigation increased rates of resolution of abnormal cancer screening findings and decreased the time it typically takes for patients to receive a diagnostic resolution.
- Patient navigation increased rates of treatment initiation among patients who typically failed to begin treatment within 90 days of a cancer diagnosis.
- Navigated patients reported improved quality of life and increased satisfaction with the health care system/cancer care compared with non-navigated patients.
- Many patients with cancer identified financial problems and medical/mental health comorbidities as main barriers to health care access, and patients with abnormal screens identified language/interpreter issues as their main barrier.
|Project Title||Principal Investigator||Population Served|
|Chicago Cancer Navigation Project||
Steven T. Rosen, M.D.
Elizabeth Calhoun, Ph.D.
|African American, Hispanic/Latino|
|DC City-wide Patient Navigation Research Program||Steven R. Patierno, Ph.D.||African American, Hispanic/Latino, Underserved|
|Improving Patient Outcomes Through System Navigation||
Peter C. Raich, M.D., F.A.C.P.
Liz Whitley, Ph.D.
|African American, Hispanic/Latino, Underserved|
|Moffitt Cancer Center Patient Navigator Program||Richard G. Roetzheim, M.D., M.S.P.H.||Hispanic/Latino, African American, Migrant Farm Worker|
|Northwest Tribal Cancer Navigator Program||Victoria Warren-Mears, Ph.D.||American Indian/ Alaska Native|
|Ohio Patient Navigator Research Program (OPNRP)||Electra Paskett, Ph.D., M.P.H.||Underserved|
|Patient Navigation in the Safety Net: CONNECTeDD||Karen M. Freund, M.D., M.P.H.||Racial/Ethnic Minorities and Low Income|
|RCT of Primary Care-based Patient Navigation-Activation||Kevin Fiscella, M.D., M.P.H.||Racial/Ethnic Minorities and Low Income|
|UTHSCSA Patient Navigation Research Program||Donald J. Dudley, M.D.||Hispanic/Latino|
- Special issue of Cancer Epidemiology, Biomarkers & Prevention featured many PNRP articles, October 2012, Volume 21.
- Bensink ME, Ramsey SD, Battaglia T, Fiscella K, Hurd TC, McKoy JM, Patierno SR, Raich PC, Seiber EE, Warren-Mears V, Whitley E, Paskett ED, Mandelblatt S; Patient Navigation Research Program. Costs and outcomes evaluation of patient navigation after abnormal cancer screening: evidence from the Patient Navigation Research Program. Cancer. 2014 Feb 15;120(4):570-8.
- Calhoun EA, Whitley EM, Esparza A, Ness E, Greene A, Garcia R, Valverde PA. A national patient navigator training program. Health Promot Pract. 2010 Mar;11(2):205-15.
- Fiscella K, Ransom S, Jean-Pierre P, Cella D, Stein K, Bauer JE, Crane-Okada R, Gentry S, Canosa R, Smith T, Sellers J, Jankowski E, Walsh K. Patient-reported outcome measures suitable to assessment of patient navigation. Cancer. 2011 Aug;117(15 Suppl):3603-17.
- Freund KM, Battaglia TA, Calhoun E, Darnell JS, Dudley DJ Fiscella K, Hare ML, LaVerda N, Lee J-H, Levine P, Murray DM, Patierno SR, Raich PC, Roetzheim RG, Simon N, Snyder FR, Warren-Mears V, Whitley EM, Winters P, Young GS, Paskett ED; and the Patient Navigation Research Program. Impact of Patient Navigation on Timely Cancer Care: The Patient Navigation Research Program. J Natl Cancer Inst (2014) 106 (6).
- Freund KM, Battaglia TA, Calhoun E, Dudley DJ, Fiscella K, Paskett E, Raich PC, Roetzheim RG; Patient Navigation Research Program Group. National Cancer Institute Patient Navigation Research Program: methods, protocol, and measures. Cancer. 2008 Dec 15;113(12):3391-9.
- Jean-Pierre P, Fiscella K, Winters PC, Paskett E, Wells K, Battaglia T; Patient Navigation Research Program Group. Psychometric validation and reliability analysis of a Spanish version of the patient satisfaction with cancer-related care measure: a patient navigation research program study. Support Care Cancer. 2012 Sep;20(9):1949-56.
- Jean-Pierre P, Fiscella K, Winters PC, Paskett E, Wells K, Battaglia T; Patient Navigation Research Program Group. Cross-cultural validation of a Patient Satisfaction with Interpersonal Relationship with Navigator measure: a multi-site patient navigation research study. Psychooncology. 2012 Dec;21(12):1309-15.
- Jean-Pierre P, Fiscella K, Winters PC, Post D, Wells KJ, McKoy JM, Battaglia T, Simon MA, Kilbourn K; Patient Navigation Research Program Group. Psychometric development and reliability analysis of a patient satisfaction with interpersonal relationship with navigator measure: a multi-site patient navigation research program study. Psychooncology. 2012 Sep;21(9):986-92.
- Roetzheim RG, Freund KM, Corle DK, Murray DM, Snyder FR, Kronman AC, Jean-Pierre P, Raich PC, Holden AE, Darnell JS, Warren-Mears V, Patierno S; PNRP Design and Analysis Committee for the Patient Navigation Research Program Investigators. Analysis of combined data from heterogeneous study designs: an applied example from the patient navigation research program. Clin Trials. 2012 Apr;9(2):176-87.
- Wells KJ, Battaglia TA, Dudley DJ, Garcia R, Greene A, Calhoun E, Mandelblatt JS, Paskett ED, Raich PC; Patient Navigation Research Program. Patient navigation: state of the art or is it science? Cancer. 2008 Oct 15;113(8):1999-2010.