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.
- 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.