Patient Navigation to Enhance Access to Care for Underserved Patients with a Suspicion or Diagnosis of Cancer

The oncologist

article

Yanin Chavarri-Guerra¹  Patricia Rojo-Castillo²  Viridiana Perez-Montessoro²  Alexandra Bukowski³  Paul E. Goss³  Enrique Soto-Perez-de-Celis²  Wendy Ramos-López¹  Sandra L. San Miguel de Majors⁴  Jesus Sanchez-Gonzalez⁵  Samuel Ahumada-Tamayo⁵  Lorena Viramontes-Aguilar⁵  Oscar Sanchez-Gutierrez⁵  Bernardo Davila-Davila⁵ 

[1] Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán;Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán;Global Cancer Institute, Massachusetts General Hospital Cancer Center, Harvard Medical School;National Cancer Institute;Ajusco Medio General Hospital Dra. Obdulia Rodríguez Rodríguez

关键词: Patient navigation;    Referral;    Developing countries;    Cancer care facilities;    Early cancer detection;   

DOI  :  10.1634/theoncologist.2018-0133

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Background Interventions aimed at improving access to timely cancer care for patients in low- and middle-income countries (LMIC) are urgently needed. We aimed to evaluate a patient navigation (PN) program to reduce referral time to cancer centers for underserved patients with a suspicion or diagnosis of cancer at a public general hospital in Mexico City. Materials and Methods From January 2016 to March 2017, consecutive patients aged >18 years with a suspicion or diagnosis of cancer seen at Ajusco Medio General Hospital in Mexico City who required referral to a specialized center for diagnosis or treatment were enrolled. A patient navigator assisted patients with scheduling, completing paperwork, obtaining results in a timely manner, transportation, and addressing other barriers to care. The primary outcome was the proportion of patients who obtained a specialized consultation at a cancer center within the first 3 months after enrollment. Results Seventy patients (median age 54, range 19–85) participated in this study. Ninety-six percent ( n = 67) identified >1 barrier to cancer care access. The most commonly reported barriers to health care access were financial burden ( n = 50) and fear ( n = 37). Median time to referral was 7 days (range 0–49), and time to specialist appointment was 27 days (range 1–97). Ninety-one percent of patients successfully obtained appointments at cancer centers in <3 months. Conclusion Implementing PN in LMIC is feasible, and may lead to shortened referral times for specialized cancer care by helping overcome barriers to health care access among underserved patients. Implications for Practice A patient navigation program for patients with suspicion or diagnosis of cancer in a second-level hospital was feasible and acceptable. It reduced patient-reported barriers, and referral time to specialized appointments and treatment initiation were within international recommended limits. Patient navigation may improve access to care for underserved patients in developing countries.

【 授权许可】

CC BY|CC BY-NC