Impact of patient navigation in eliminating economic disparities in cancer care.
Impact of patient navigation in eliminating economic disparities in cancer care.
复制标题
DOI：
10.1002/cncr.29612
复制
发表时间：
2015-11-15
期刊：
影响因子：
6.2
通讯作者：
Freund KM
中科院分区：
文献类型：
--
作者：
Rodday AM;Parsons SK;Snyder F;Simon MA;Llanos AA;Warren-Mears V;Dudley D;Lee JH;Patierno SR;Markossian TW;Sanders M;Whitley EM;Freund KM
患者导航可以减少与社会经济地位（SES）和家庭因素相关的癌症差异。我们研究了这些因素是否与癌症筛查异常患者的诊断解决延迟有关，以及患者导航是否改善了这些延迟。我们分析了NCI患者导航研究项目中十个中心中的五个中心的数据，这些中心收集了SES和家庭就业、收入、教育、住房、婚姻状况和家庭组成方面的数据。主要结果是癌症筛查异常后诊断解决的时间。我们对每个社会地位和家庭因素分别拟合了调整后的Cox比例风险模型，并纳入了该因素与干预状态之间的相互作用。在3777名参与者中（n=1968对照，n=1809导航干预），91%为女性，平均年龄44岁，43%为西班牙裔，28%为白人，27%为非洲裔美国人。在控制组中，失业者比全职就业者的解决时间更长（HR=0.85, p=0.02）。租房者（HR=0.81, p=0.02）和拥有其他（即不稳定）住房的人（HR=0.60, p<0.001）比房主延迟。从未结婚（HR=0.70, p<0.001）和曾经结婚的参与者（HR=0.85, p=0.03）比已婚参与者有更长的关心时间。在导航干预臂内，任何这些变量到诊断分辨率的时间都没有差异。延误诊断解决存在的就业，住房类型和婚姻状况。患者导航在我们的研究样本中消除了这些差异。我们的研究结果证明了为癌症治疗延迟的高风险患者提供患者导航的价值。
Patient navigation may reduce cancer disparities associated with socioeconomic status (SES) and household factors. We examined whether these factors were associated with delays in diagnostic resolution among patients with cancer screening abnormalities and whether patient navigation ameliorated these delays. We analyzed data from five of ten centers from the NCI Patient Navigation Research Program that collected SES and household data on employment, income, education, housing, marital status, and household composition. The primary outcome was time to diagnostic resolution following a cancer screening abnormality. We fit separate adjusted Cox proportional hazard models for each SES and household factor and included an interaction between that factor and intervention status. Among 3777 participants (n=1968 control, n=1809 navigation intervention), 91% were women, with a mean age of 44 years, and 43% were Hispanic, 28% White, and 27% African American. Within the control arm, the unemployed experienced longer time to resolution than the full-time employed (HR=0.85, p=0.02). Renters (HR=0.81, p=0.02) and those with other (i.e., unstable) housing (HR=0.60, p<0.001) had delays compared to homeowners. Never married (HR=0.70, p<0.001) and previously married participants (HR=0.85, p=0.03) had longer time to care than married participants. There were no differences in time to diagnostic resolution by any of these variables within the navigation intervention arm. Delays in diagnostic resolution exist by employment, housing type, and marital status. Patient navigation eliminated these disparities in our study sample. Our findings demonstrate the value of providing patient navigation to patients at high risk for delays in cancer care.