Abstract B82: Beyond October: A multisite breast care patient navigation program
Authors: Knight Jimmie , Francois Teena L. 
Published: May 2015

Background: Insufficient access to mammography and early detection are contributing factors to the racial disparity in breast cancer mortality in Chicago (Chicago Breast Cancer Quality Consortium, 2010). Patient navigators provide information, support, and guidance that can help remove barriers to care and improve the quality of disease management for underserved patients (Vargas et al, 2008). The Metropolitan Chicago Breast Cancer Task Force developed a patient navigation program called Beyond October to provide free mammograms to uninsured and underserved women throughout Metropolitan Chicago. Our goal is to develop a replicable and effective means for patient navigation across multiple sites. Through navigation from Task Force staff, these women received timely and managed care through the screening, and if necessary, diagnostic and treatment processes.

Methods: Nine facilities in various locations throughout Chicago donated free mammograms in order to meet our program's goal of 800 mammograms completed from November 1, 2012 to October 31, 2013. Participants were identified through community events, online applications, personal referrals, and referrals from other hospitals and organizations. To be eligible participants were over 40 years of age, uninsured and without symptoms. Eligible participants received culturally sensitive navigation throughout the screening and, if needed, diagnostic process from bilingual staff navigators. A staff navigator (4 navigators in total) verified the patient's eligibility prior to the patient completing intake and HIPAA authorization forms necessary to receive an appointment. Participants were navigated to a facility that was most convenient to their home address and received a packet of site-specific forms, as well as a voucher, to take to their appointment. Each patient received reminder and follow-up calls to assure appointment attendance. If the initial appointment was missed, a patient would receive one more attempt at attending the appointment. Navigators ensured appointments were scheduled, prior mammogram films were requested and obtained. After the appointment, results were communicated effectively and the necessary follow-up imaging and procedures were scheduled. Any patients requiring follow-up imaging and/or biopsies who did not receive their initial mammogram at a site that donated diagnostic mammograms, were referred to an IBCCP (state funded) facility. Women diagnosed with breast cancer received free treatment through the Treatment Act.

Results: Based on preliminary data, a total of 662 mammograms were completed across nine Chicago facilities. From this pilot, successful outcomes were observed in the areas of client recruitment, communication of results, and care management for each woman. The program identified economic, language, and administrative /health system barriers as the main challenges faced by women. These barriers were addressed by: 1) providing access to free screening and diagnostic breast health care, 2) providing translation assistance for Spanish speaking clients, and 3) obtaining PCP orders and prior medical information to reduce health system barriers. Developing site specific protocols, providing patients with site specific forms, and having designated facility contacts decreased scheduling times and increased the rate of completion of the specific care plan for each participant. Delays occurred when medical information had to be sent across multiple sites, requests for prior medical history were not properly documented, and patients had a high number of forms to complete.

Conclusion: A multi-site, culturally sensitive navigation program that takes into account both patient and facility needs can reduce screening barriers and increase access to quality breast health care for uninsured women.

Citation Format: Jimmie Knight, III, Teena L. Francois. Beyond October: A multisite breast care patient navigation program. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B82. doi:10.1158/1538-7755.DISP13-B82