Emily C Serrell1, Moritz Hansen1,2,3, Greg Mills2,3, Andrew Perry4, Tracy Robbins4, Melanie Feinberg4, Scot C Remick4, Lisa Beaule1,2, Matt Hayn1,2, Tom Kinkead1,2, Paul K J Han1,3, Jesse D Sammon5,6,7. 1. Tufts University School of Medicine, Boston, MA, USA. 2. Division of Urology, Maine Medical Center, Portland, ME, USA. 3. Center for Outcomes Research and Evaluation, Maine Medical Center, 509 Forest Avenue, Suite 200, Portland, ME, 04101, USA. 4. Maine Medical Center Cancer Institute, Scarborough, ME, USA. 5. Tufts University School of Medicine, Boston, MA, USA. jsammon79@gmail.com. 6. Division of Urology, Maine Medical Center, Portland, ME, USA. jsammon79@gmail.com. 7. Center for Outcomes Research and Evaluation, Maine Medical Center, 509 Forest Avenue, Suite 200, Portland, ME, 04101, USA. jsammon79@gmail.com.
Abstract
OBJECTIVE: To evaluate factors associated with use of patient navigation in a prostate cancer population and identify whether navigation is associated with prolonged time to care. Cancer patient navigation has been shown to improve access to cancer screening, diagnosis, and treatment, but little is known about patient navigation in prostate cancer care. METHODS: All men diagnosed with localized prostate cancer between 2009 and 2015 were abstracted from the MaineHealth multi-specialty tumor registry. Regression analyses controlling for patient-, disease-, and system-level factors evaluated characteristics associated with navigation utilization. The association between navigation utilization, barriers to care, and longer time to treatment was assessed with Cox proportional hazards regression. RESULTS: Of the patient population (n = 1587), 85% of men were navigated. Navigation use was associated with earlier year of diagnosis, treatment by a high-volume urologist, and lower risk disease (p < 0.05). Treatment delay was associated with low-risk disease (vs: intermediate OR 0.62, 95% CI 0.46-0.85 and high OR 0.16, 95% CI 0.1-0.25) and receipt of navigation services (OR 1.65, 95% CI 1.12-2.45) but not distance to care, insurance, or treatment choice. CONCLUSIONS: We observed that patients with low-risk prostate cancer were more likely to utilize navigation, but traditional barriers to care were not associated with utilization. Navigation was associated with longer time to treatment, which likely reflects clinically appropriate delays associated with greater shared decision making. Time to treatment may not be the ideal metric for evaluating navigation in prostate cancer; shared decision making, patient satisfaction, and psychosocial outcomes may be more appropriate.
OBJECTIVE: To evaluate factors associated with use of patient navigation in a prostate cancer population and identify whether navigation is associated with prolonged time to care. Cancerpatient navigation has been shown to improve access to cancer screening, diagnosis, and treatment, but little is known about patient navigation in prostate cancer care. METHODS: All men diagnosed with localized prostate cancer between 2009 and 2015 were abstracted from the MaineHealth multi-specialty tumor registry. Regression analyses controlling for patient-, disease-, and system-level factors evaluated characteristics associated with navigation utilization. The association between navigation utilization, barriers to care, and longer time to treatment was assessed with Cox proportional hazards regression. RESULTS: Of the patient population (n = 1587), 85% of men were navigated. Navigation use was associated with earlier year of diagnosis, treatment by a high-volume urologist, and lower risk disease (p < 0.05). Treatment delay was associated with low-risk disease (vs: intermediate OR 0.62, 95% CI 0.46-0.85 and high OR 0.16, 95% CI 0.1-0.25) and receipt of navigation services (OR 1.65, 95% CI 1.12-2.45) but not distance to care, insurance, or treatment choice. CONCLUSIONS: We observed that patients with low-risk prostate cancer were more likely to utilize navigation, but traditional barriers to care were not associated with utilization. Navigation was associated with longer time to treatment, which likely reflects clinically appropriate delays associated with greater shared decision making. Time to treatment may not be the ideal metric for evaluating navigation in prostate cancer; shared decision making, patient satisfaction, and psychosocial outcomes may be more appropriate.
Entities:
Keywords:
Patient navigation; Prostate cancer; Quality improvement; Shared decision making
Authors: Lixin Song; Ronald C Chen; Jeannette T Bensen; George J Knafl; Matthew E Nielsen; Laura Farnan; Eric M Wallen; Merle Mishel; Raj S Pruthi; James L Mohler; Paul A Godley Journal: Cancer Date: 2012-07-11 Impact factor: 6.860
Authors: Philippe D Violette; Thomas Agoritsas; Paul Alexander; Jarno Riikonen; Henrikki Santti; Arnav Agarwal; Neera Bhatnagar; Philipp Dahm; Victor Montori; Gordon H Guyatt; Kari A O Tikkinen Journal: CA Cancer J Clin Date: 2015-03-12 Impact factor: 508.702
Authors: Karen M Freund; Tracy A Battaglia; Elizabeth Calhoun; Donald J Dudley; Kevin Fiscella; Electra Paskett; Peter C Raich; Richard G Roetzheim Journal: Cancer Date: 2008-12-15 Impact factor: 6.860
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: Kristen J Wells; Tracy A Battaglia; Donald J Dudley; Roland Garcia; Amanda Greene; Elizabeth Calhoun; Jeanne S Mandelblatt; Electra D Paskett; Peter C Raich Journal: Cancer Date: 2008-10-15 Impact factor: 6.860
Authors: France Légaré; Dawn Stacey; Stéphane Turcotte; Marie-Joëlle Cossi; Jennifer Kryworuchko; Ian D Graham; Anne Lyddiatt; Mary C Politi; Richard Thomson; Glyn Elwyn; Norbert Donner-Banzhoff Journal: Cochrane Database Syst Rev Date: 2014-09-15
Authors: Melissa A Simon; Narissa J Nonzee; June M McKoy; Dachao Liu; Thanh Ha Luu; Peter Byer; Elizabeth A Eklund; Elizabeth A Richey; Zhigang Wu; XinQi Dong; Alfred W Rademaker Journal: BMC Health Serv Res Date: 2013-08-15 Impact factor: 2.655
Authors: Ryan W Dobbs; James Stinson; Shaleen R Vasavada; Brandon M Caldwell; Vincent L Freeman; Daniel F Garvey; Jack Lu; Daniel M Moreira; Michael R Abern Journal: J Community Health Date: 2020-06