Patient Navigation for Cervical Cancer in Appalachia

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DESCRIPTION (provided by applicant): Over the past five decades, mortality rates from cervical cancer have decreased by approximately 75%. This reduction is largely attributable to the Pap smear and improvements in treatment. Despite this encouraging reduction, certain groups of women have not experienced significant benefits and remain at disproportionate risk of death from cervical cancer. Among these women are those living in rural areas, particularly middle aged and older women who live in rural Appalachia. This population continues to have among the highest cervical cancer mortality rates, and efforts to address this problem have fallen short of their objectives. To reduce the unequal and unnecessary burden from cervical cancer experienced by rural Appalachian women, we propose to undertake a community-based patient navigator (PN) intervention in partnership with local public health departments. In this proposed project we intend to develop, administer, and evaluate a plan for effective utilization of lay health workers as PNs in local health department cervical cancer screening programs. The aims are: 1) to improve understanding of the barriers to follow-up experienced by women with abnormal Pap test results; 2) in conjunction with designated nurse case managers, to recruit, train and utilize lay health workers as PNs in local health departments' cervical cancer screening and follow-up treatment programs; and 3) with extensive input from women who do not follow-up after abnormal results and through the development of a PN program, to increase the proportion of patients who are adherent with recommendations for timely abnormal Pap test follow-up. The project will be conducted in 26 public health departments in rural southeastern Kentucky. A lagged design will be used in which the health departments will be randomized to intervention or delayed intervention groups. A total of 858 patients will be enrolled in the project, 429 in the intervention group and 429 in the delayed intervention group. Patients who do not keep scheduled follow-up appointments for abnormal Pap smear results will be eligible and referred to PNs and enrolled. Assessment will occur in face-to-face interviews at baseline and again at two points after the intervention.