Abstract B65: Network Patient Navigation: An integrative, longitudinal model to reduce breast cancer disparities

To combat a significant differential in breast cancer mortality in minorities compared to whites in Washington, DC, the George Washington Cancer Institute (GWCI) instituted the DC Citywide Patient Navigation Research Program (DC-PNRP). While included among the 9 PNRP National sites funded by NCI to evaluate the effectiveness of patient navigation, the DC site is unique in its approach. Navigators from several unaffiliated clinical and community sites across DC were trained to work collaboratively to enroll patients in the research study, increase screening rates, and assure each patient receives timely, quality care. Many difficulties inherent to a complex citywide network were encountered and overcome including problems with administrative coordination, different operating procedures, and varying IRB requirements. Frequent trainings, efforts that promote increased communication between navigators, and sharing of information about community resources were implemented to enhance care coordination and to assure appropriate referral strategies such that navigators at screening sites “hand-off” patients to navigators at treatment sites. This integrative approach assures longitudinal navigation coverage for the patient from point of suspicious finding through treatment and into survivorship. It represents an innovative and creative way to address the barriers to access and underlying fragmentation of services that exist in DC for low-income uninsured or under-insured women. In developing DC-PNRP, GWCI learned that the same barriers affecting access to treatment also interfere with access to, and utilization of, screening programs, suggesting that “screening navigation” will overcome these barriers when integrated longitudinally with our outreach, education, and diagnostic services. Many reports suggest the barriers that underlie treatment disparities also contribute to survivorship disparities indicating that “survivorship navigation” integrated longitudinally with both treatment navigation and, when necessary, palliative care and end-of-life-care, may help overcome these barriers and facilitate the often stressful period of transition from active care. Hence, GWCI has developed the concept of “Longitudinal Navigation”, or navigation integrated across the full health care continuum. Our objective is to maintain the DC-PNRP framework for Network Navigation for use with other types of cancer and to expand the integrative navigation services longitudinally at both ends of the spectrum to improve health care access for all residents of the DC metro area, particularly the underserved. By increasing the effectiveness of our outreach services using navigators who will direct residents to low-cost screening facilities, those with suspicious findings will become integrated within our already established navigation network. Patients diagnosed with cancer will then be followed through the treatment process and survivorship becoming integrated within our longitudinal navigation network. Our experience with DC-PNRP has shown that navigation services positioned at various points in the healthcare system and linked to one another through systems of care coordination can reduce fragmentation, increase patient satisfaction, and improve adherence to life saving treatments.