Abstract A91: Healthcare reform: Closing the health disparities gap. Where does patient navigation belong?
Authors: Preston Michael A. , Glover-Collins Katherine , Gray Dale , Smith Sharla , Henry-Tillman Ronda 
Published: August 2014

Abstract
Background: Prostate cancer is the most commonly diagnosed cancer and second leading cause of cancer death in the US among men. Although overall incidence and mortality has decreased over time, disparities still exist among racial/ethnic groups. Strategies to reduce disparities in cancer detection, treatment, and outcomes among racial/ethnic minorities and low-income patients have been gathering momentum with the introduction of patient navigation (PN) initiatives. The current advancement of medical knowledge and technology spurs a widening gap in healthcare delivery for racial/ethnical minorities and medically underserved populations for certain emerging state-of-the-art treatments. The controversy around the effectiveness of prostate-specific antigen (PSA) and digital rectal exam (DRE) as screening tools was cited as a possible reason for this information void, but research suggests that African American males rely on their physicians to recommend all needed tests/screenings. The study examined the current and potential roles of PN in the improvement of prostate cancer screenings among disadvantaged populations.
Methods: A Longitudinal study design was conducted on males over 35 years of age to examine the role of patient navigation on equity of access to prostate cancer screening among disadvantaged populations since 2008 (n=1602). Patient's demographics, geographical location, PSA scores, and DRE scores, and the array of event types in which community engagement occurred were collected. Data were analyzed using comparison analyses.
Results: Patient navigation allowed for greater utilization of health services among populations of rural origins (Urban: n=747; Rural: n=833). Mean PSA scores were within normal range, although mean PSA scores for non-whites residing in rural areas (1.45ng/mL) was slightly higher than non-whites in urban areas of the state (1.36ng/mL; p=0.03). The mean age was 54 years (Urban: 51 years; Rural: 56 years; p=0.001).
Conclusions: Equity of access to cancer screenings among disadvantaged populations may be achieved with the utilization of patient navigation programs. Access to the health care system is a strong barrier which fosters disparities among disadvantaged populations. PN allows rural disadvantaged populations entry into the health care system at earlier stages, considering PSA as a proxy for disease. Health care reform lays the foundation for preventative programs such as patient navigation.
Citation Format: Michael A. Preston, Katherine Glover-Collins, Dale Gray, Sharla Smith, Ronda Henry-Tillman. Healthcare reform: Closing the health disparities gap. Where does patient navigation belong? [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 A91.