TY - JOUR
T1 - Effectiveness of Patient Navigation to Increase Cancer Screening in Populations Adversely Affected by Health Disparities
T2 - a Meta-analysis
AU - Nelson, Heidi D.
AU - Cantor, Amy
AU - Wagner, Jesse
AU - Jungbauer, Rebecca
AU - Fu, Rongwei
AU - Kondo, Karli
AU - Stillman, Lucy
AU - Quiñones, Ana
N1 - Funding Information:
This review was funded by the National Institutes of Health Office of Disease Prevention through an interagency agreement with the Agency for Healthcare Research and Quality (Contract No. 290-2015-00009I). Acknowledgments
Funding Information:
This review was funded by the National Institutes of Health (NIH) Office of Disease Prevention through an interagency agreement with the Agency for Healthcare Research and Quality (Contract No. 290-2015-00009I). Agency staff, an NIH Office of Disease Prevention working group, an NIH content area expert group, and a technical expert panel helped refine the project scope. The draft report was presented at an NIH Office of Disease Prevention Pathways to Prevention Workshop. Experts in the field, AHRQ and NIH partners, and the public reviewed earlier drafts of the full technical report. The investigators are solely responsible for the content and the decision to submit the manuscript for publication.
Publisher Copyright:
© 2020, Society of General Internal Medicine.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Background: This study evaluates the effectiveness of patient navigation to increase screening for colorectal, breast, and cervical cancer in populations adversely affected by health care disparities. Methods: Eligible studies were identified through English-language searches of Ovid® MEDLINE®, PsycINFO®, SocINDEX, and Veterans Affairs Health Services database (January 1, 1996, to July 5, 2019) and manual review of reference lists. Randomized trials and observational studies of relevant populations that evaluated the effectiveness of patient navigation on screening rates for colorectal, breast, or cervical cancer compared with usual or alternative care comparison groups were included. Two investigators independently abstracted study data and assessed study quality and applicability using criteria adapted from the U.S. Preventive Services Task Force. Discrepancies were resolved by consensus with a third reviewer. Results were combined using profile likelihood random effects models. Results: Thirty-seven studies met inclusion criteria (28 colorectal, 11 breast, 4 cervical cancers including 3 trials with multiple cancer types). Screening rates were higher with patient navigation for colorectal cancer overall (risk ratio [RR] 1.64; 95% confidence interval [CI] 1.42 to 1.92; I2 = 93.7%; 22 trials) and by type of test (fecal occult blood or immunohistochemistry testing [RR 1.69; 95% CI 1.33 to 2.15; I2 = 80.5%; 6 trials]; colonoscopy/endoscopy [RR 2.08; 95% CI 1.08 to 4.56; I2 = 94.6%; 6 trials]). Screening was also higher with navigation for breast cancer (RR 1.50; 95% CI 1.22 to 1.91; I2 = 98.6%; 10 trials) and cervical cancer (RR 1.11; 95% CI 1.05 to 1.19; based on the largest trial). The high heterogeneity of cervical cancer studies prohibited meta-analysis. Results were similar for colorectal and breast cancer regardless of prior adherence to screening guidelines, follow-up time, and study quality. Conclusions: In populations adversely affected by disparities, colorectal, breast, and cervical cancer screening rates were higher in patients provided navigation services.
AB - Background: This study evaluates the effectiveness of patient navigation to increase screening for colorectal, breast, and cervical cancer in populations adversely affected by health care disparities. Methods: Eligible studies were identified through English-language searches of Ovid® MEDLINE®, PsycINFO®, SocINDEX, and Veterans Affairs Health Services database (January 1, 1996, to July 5, 2019) and manual review of reference lists. Randomized trials and observational studies of relevant populations that evaluated the effectiveness of patient navigation on screening rates for colorectal, breast, or cervical cancer compared with usual or alternative care comparison groups were included. Two investigators independently abstracted study data and assessed study quality and applicability using criteria adapted from the U.S. Preventive Services Task Force. Discrepancies were resolved by consensus with a third reviewer. Results were combined using profile likelihood random effects models. Results: Thirty-seven studies met inclusion criteria (28 colorectal, 11 breast, 4 cervical cancers including 3 trials with multiple cancer types). Screening rates were higher with patient navigation for colorectal cancer overall (risk ratio [RR] 1.64; 95% confidence interval [CI] 1.42 to 1.92; I2 = 93.7%; 22 trials) and by type of test (fecal occult blood or immunohistochemistry testing [RR 1.69; 95% CI 1.33 to 2.15; I2 = 80.5%; 6 trials]; colonoscopy/endoscopy [RR 2.08; 95% CI 1.08 to 4.56; I2 = 94.6%; 6 trials]). Screening was also higher with navigation for breast cancer (RR 1.50; 95% CI 1.22 to 1.91; I2 = 98.6%; 10 trials) and cervical cancer (RR 1.11; 95% CI 1.05 to 1.19; based on the largest trial). The high heterogeneity of cervical cancer studies prohibited meta-analysis. Results were similar for colorectal and breast cancer regardless of prior adherence to screening guidelines, follow-up time, and study quality. Conclusions: In populations adversely affected by disparities, colorectal, breast, and cervical cancer screening rates were higher in patients provided navigation services.
KW - cancer screening
KW - health disparity
KW - health equity
KW - patient navigation
KW - prevention
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U2 - 10.1007/s11606-020-06020-9
DO - 10.1007/s11606-020-06020-9
M3 - Review article
C2 - 32700218
AN - SCOPUS:85088463965
SN - 0884-8734
VL - 35
SP - 3026
EP - 3035
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 10
ER -