Abstract PR-6: Does racial/ethnic concordance between patients and their navigators increase identification of barriers to care?
Authors: Santana M. Christina , Freund Karen M. , Bak Sharon M. , Beaver Kristine , Evans Steven R. , Battaglia Tracy A. 
Published: December 2010

Background: Racial/ethnic minority groups have higher cancer mortality rates and experience more barriers in receiving cancer care compared to their white counterparts. Recent literature, suggests patients receiving care from providers who are racially/ethnically concordant have improved patient satisfaction. Our long term hypothesis is that racial/ethnic concordant navigators would identify more barriers to care, and by addressing these identified barriers, improve patient outcomes.

Study Intervention: Boston is part of the NCI CRCHD Patient Navigation Research Program (PNRP). Boston's aim is to develop and test patient navigation as an intervention to increase timely resolution after identification of a breast or cervical screening abnormality. We partnered with six of Boston's community health centers; three received breast navigation and three received cervical navigation, each serving as a control site for the other cancer type.

Study Objective: The aim of this study was to examine the association of racial/ethnic concordance and barrier identification between participants and navigators. Study Design: Participants were included if they were enrolled in the navigation arm between January 2007 and May 2008, had an abnormal mammogram (BIRADS 0,3,4 or 5) or Pap test (ASCUS HPV+, LGSIL, or HGSIL). Racial/ethnic data was collected administratively. Navigators recorded identified barriers to care from a checklist of 19 predetermined categories. Measures: Participant and navigator race/ethnicity was collapsed into a single, mutually exclusive variable. Each participant was categorized as concordant or discordant with her navigator. For participants navigated by more than one navigator, the navigator with the most patient contacts was used. For this analysis, participants were dichotomized as having no versus any barriers identified. Language was also excluded as a potential barrier to remove potential confounding by concordance.

Results: Preliminary results (N=870) indicate that 29% of the participants were white, 28% black, 31 % Latina, and 12% Asian; mean age 40 (± 14); 62% spoke English; 56% were on public insurance. Of the 17 navigators, 59% were white, 18% black, 18% Latina, and 5% Asian. Racial/ethnic minority participants had more identified barriers compared to whites (70% vs. 52%, p=.0001). More Asian participants had barriers identified with concordant than discordant navigators (100% vs. 71 %, p=.0001) while concordance and barrier identification was not associated among white, black, or Latina participants.

Conclusion: Racial/ethnic minority participants had more barriers identified than white participants. Concordance was significantly associated with barrier identification for Asian participants but not white, black, or Latina participants. Our future research will explore clinical outcomes and concordance to understand the impact of racial/ethnic concordance among these groups.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):PR-6.