Patient Navigators Address Barriers to Cancer Screening for Elderly Latinos

Patient navigators facilitated almost 700 cancer screenings among Latino Medicare beneficiaries through a cancer prevention and treatment demonstration project for ethnic and racial minorities at the University of Medicine and Dentistry of New Jersey (UMDNJ). The project seeks to address disparities in cancer screening rates in the elderly Latino population in the Newark, New Jersey, area. The project also is evaluating the impact of navigators to facilitate that screening.

Building on Dr Harold Freeman’s original model of navigation, Ana Natale- Pereira, MD, MPH, and her team of patient navigators have enrolled 1273 Latino Medicare beneficiaries into a randomized, controlled trial. To date, patients in the intervention group, that is, those who had direct contact with a navigator, have completed 289 mammograms, 136 Pap smears, 139 prostate screening tests, and 129 colonoscopies as a direct result of the facilitation of services provided through patient navigation.

Part of the success of the program stems from identifying the appropriate people to be patient navigators. “Navi - gators by nature have to be related to the community that the patients come from—understanding the community and its cultural side, not just geographically knowing the community,” explains Natale-Pereira, who is the project’s principal investigator and associate professor of medicine and the UMDNJ-New Jersey Medical School. “Our program navigators are all Spanish speaking; the entire program has been done in Spanish. They come from the community we serve.” In addition, the navigators have selfless personalities and the ability to problemsolve. “These are people who know how to get from point A to point B to point C and have the same easiness in communication speaking with the patients and with the doctors. They are highly wired connectors of the healthcare system. Their job is to reduce barriers.”

Natale-Pereira’s previous projects identified the main barriers for their population, which provided a framework for the current interventions: language, transportation, cultural/religious beliefs, fear of and lack of trust in the healthcare system, and a lack of knowledge about cancer prevention.

All participants completed a baseline questionnaire and received educational materials on a quarterly basis. The control group, however, did not receive access to a navigator, allowing the researchers to see if the educational materials alone would influence their medical decision-making. Members of the intervention group were in direct and ongoing contact with patient navigators. This contact offered many benefits. Natale-Pereira gave this example: After asking patients about their previous cancer screenings, the navigators followed-up by obtaining medical records, which can confirm the information’s validity and facilitate the appropriate screenings. “Some participants will tell you they get a mammogram every year, but then when you actually get medical records, they don’t. Some people will say that they haven’t had any screening tests done in 3 years, but they actually did and the records will show it. Navigation becomes more efficient this way.”

Additional benefits are realized when navigators encounter issues that interfere with a patient’s ability to adhere to screening guidelines, such as issues related to housing or transportation. The navigators then address those barriers. “We facilitate the process, we help them make appointments, we help them keep the appointments, we remind them about the colonoscopy procedure and the preparation for the colonoscopy,” Natale-Pereira tells the academy.

These efforts show not only that patient navigation can increase screening rates among minorities but also that it can increase this population’s satisfaction with the healthcare system. The UMDNJ demonstration project’s preliminary data show participant satisfaction with the navigator to be more than 90%. Most importantly, on a subsequent assessment of satisfaction, participants were significantly more successful in identifying “what is a navigator” compared with baseline. This has major implications in defining the navigator in the Latino community as a resource and trustworthy helper.