Effectiveness of Patient Navigation to Increase Cancer Screening in Populations Adversely Affected by Health Disparities
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Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA; 2Department of Medicine, Oregon Health & Science University, Portland, OR, USA; 3Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA; 4School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA; 5Evidence-based Synthesis Program, Portland VA Health Care System, Portland, OR, USA; 6Office of Research Integrity, Oregon Health & Science University, Portland, OR, USA.
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
Prior Presentations: National Institutes of Health sponsored Pathways to Prevention Workshop on Achieving Health Equity in Preventive Services; Bethesda, Maryland; June 19–20, 2019. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-06020-9) contains supplementary material, which is available to authorized users. Received May 30, 2020 Accepted June 30, 2020
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 screenin
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