Patient Navigation Research Program (PNRP)

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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.

Overview

  • 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.

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).

Goals

  • 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.

Research Questions

The PNRP addressed four research questions:

  1. 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?
  2. 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?
  3. Does patient navigation increase patients’ satisfaction with the health care system and, specifically, cancer-related care?
  4. Is patient navigation cost effective?

Read the PNRP Request for Applications (RFA)

Summary of Key Findings & Outcomes 

  • 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 Listing

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

Joint Publications

Resources

  • Posted: February 17, 2015