BACKGROUND: A high rate of low-income, ethnic minority women delay or fail to keep appointments following abnormal mammograms. This study was designed to test the effectiveness of a structured counseling and patient navigation intervention for improving follow-up rates at a large public sector medical center. METHODS: This randomized clinical trial, conducted in Los Angeles 2001-2002, included 204 women with abnormal mammograms referred for follow-up who were then assigned to intervention or usual care. The primary outcome was the rate of follow-up through diagnostic resolution within eight months. RESULTS: The intervention resulted in a significant increase in the rate of adherence to follow-up through diagnostic resolution. The intervention group was much more likely to be adherent through diagnostic resolution than the control group (90% vs. 66%, OR=4.48, p<0.001) and were more likely to experience timely adherence than UC patients (77% vs. 57%, OR=2.5, p=0.01). Intervention effectiveness was not significantly different for women assigned to different levels of service intensity. CONCLUSIONS:Patient navigation and counseling driven by a structured clinical algorithm are highly effective strategies to improve diagnostic resolution follow-up among low-income, ethnic minority women with abnormal mammograms. The intervention algorithm and available training materials can be adapted for diverse care systems serving high-risk women to decrease loss to follow-up.
RCT Entities:
BACKGROUND: A high rate of low-income, ethnic minority women delay or fail to keep appointments following abnormal mammograms. This study was designed to test the effectiveness of a structured counseling and patient navigation intervention for improving follow-up rates at a large public sector medical center. METHODS: This randomized clinical trial, conducted in Los Angeles 2001-2002, included 204 women with abnormal mammograms referred for follow-up who were then assigned to intervention or usual care. The primary outcome was the rate of follow-up through diagnostic resolution within eight months. RESULTS: The intervention resulted in a significant increase in the rate of adherence to follow-up through diagnostic resolution. The intervention group was much more likely to be adherent through diagnostic resolution than the control group (90% vs. 66%, OR=4.48, p<0.001) and were more likely to experience timely adherence than UC patients (77% vs. 57%, OR=2.5, p=0.01). Intervention effectiveness was not significantly different for women assigned to different levels of service intensity. CONCLUSIONS:Patient navigation and counseling driven by a structured clinical algorithm are highly effective strategies to improve diagnostic resolution follow-up among low-income, ethnic minority women with abnormal mammograms. The intervention algorithm and available training materials can be adapted for diverse care systems serving high-risk women to decrease loss to follow-up.
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Authors: Erica T Warner; Rulla M Tamimi; Melissa E Hughes; Rebecca A Ottesen; Yu-Ning Wong; Stephen B Edge; Richard L Theriault; Douglas W Blayney; Joyce C Niland; Eric P Winer; Jane C Weeks; Ann H Partridge Journal: Breast Cancer Res Treat Date: 2012-10-26 Impact factor: 4.872
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Authors: Karen M Freund; Tracy A Battaglia; Elizabeth Calhoun; Julie S Darnell; Donald J Dudley; Kevin Fiscella; Martha L Hare; Nancy LaVerda; Ji-Hyun Lee; Paul Levine; David M Murray; Steven R Patierno; Peter C Raich; Richard G Roetzheim; Melissa Simon; Frederick R Snyder; Victoria Warren-Mears; Elizabeth M Whitley; Paul Winters; Gregory S Young; Electra D Paskett Journal: J Natl Cancer Inst Date: 2014-06-17 Impact factor: 13.506
Authors: Yaminette Diaz-Linhart; Michael Silverstein; Nancy Grote; Lynn Cadena; Emily Feinberg; Betty J Ruth; Howard Cabral Journal: Soc Work Public Health Date: 2016-05-19