Abstract B55: Barriers to care reported among patients with cervical and breast abnormalities in the Ohio Patient Navigation Research Program.
Authors: Katz Mira L. , Reiter Paul L. , Young G. , Paskett Electra D. 
Published: August 2014

Purpose: To evaluate patient-reported barriers to care among patients with cervical and breast abnormalities in the Ohio Patient Navigation Research Program.

Methods: Patients from 18 primary care and specialty clinics within the Ohio State University Medical Center and Columbus Neighborhood Health Centers with an abnormal cervical or breast cancer screening test were eligible for this group-randomized trial. Clinics were paired and randomized within pairs to usual care or patient navigation (PN). Navigators were not clinic-based, but followed the American Cancer Society-PN model where navigators mainly used phone contact from a non-clinic location. During conversations, the navigators documented patient-reported barriers, actions taken to address barriers, and the amount of time spent. We report data on 406 patients with cervical (n=150) or breast (n=256) abnormalities from clinics assigned to the PN arm and who were reached and did not refuse navigation. Differences between patient groups were compared using t-test (demographics) and Fisher's exact test (barriers). Cox proportional hazard models examined the effects of barriers on time to resolution (i.e., cancer diagnosis or determination of a benign condition) of patients' abnormalities.

Results: Patients with breast abnormalities were older than patients with cervical abnormalities (mean age: 53 vs. 36 years; p&lt;0.01). Additionally, more patients with breast abnormalities were: married; had higher levels of education and income; owned their home; were retired, and had some form of health insurance than patients with cervical abnormalities (all p&lt;0.01). Approximately half (48%) of the patients reported no barriers. More cervical than breast patients reported having a language barrier and needed assistance with interpretation (3% vs. 0; p&lt;0.05). The patient-reported barriers most commonly reported, but not statistically significant, among cervical and breast patients were: communication concerns with providers (19% vs. 12%), perceptions and beliefs about tests or treatment (18% vs. 16%), system problems with scheduling care (15% vs. 9%); insurance (11% vs. 6%), employment issues (3% vs. 1%), co-morbidities (10% vs. 5%), and not a priority (9% vs. 6%). In multivariable models, both breast (OR=0.66; 95% CI: 0.51–0.86) and cervical patients (OR=0.56; 95% CI: 0.38–0.82) who reported at least one barrier had slower resolution of their abnormalities.

Conclusions: Patients with breast and cervical abnormalities reported similar barriers to care. However, patients with cervical abnormalities reported the barriers more often, which may be due to differences in key demographic characteristics. Patients who reported at least one barrier were slower to resolution of their abnormality and the most common barriers reported provide clues as to where the health care system is breaking down for patients and how patient navigation can help.

Citation Format: Mira L. Katz, Paul L. Reiter, G. Young, Electra D. Paskett. Barriers to care reported among patients with cervical and breast abnormalities in the Ohio Patient Navigation Research Program. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B55.