Disparities of Care: Navigation System Helps Connect Underserved Populations to Cancer Services


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The trend of higher completion of cancer control behaviors among participants who received navigation was clear: Colorectal cancer screening increased by 40%, mammography increased by 17%, human papillomavirus vaccination of daughters increased by 43%, and participation in smoking cessation programs increased by 90%.
— Maria E. Fernandez, PhD

Although we’ve seen substantial progress in cancer treatment, screening, diagnosis, and prevention over the past decades, certain underserved populations have not reaped the benefits of many of these advances. Turning research into actionable programs in this area was highlighted by a presentation at the 9th American Association of Cancer Research (AACR) Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved by Maria E. Fernandez, PhD, Director, Center for Health Promotion and Prevention Research, the University of Texas Health Science Center at Houston School of Public Health.1

Dr. Fernandez led a Texas-based study looking at how adding health navigation services to national 2-1-1 call centers might help underserved Texans to receive cancer control measures such as Papanicolaou (Pap) tests and smoking cessation help. “The 2-1-1 number is a three-digit nationally designated telephone number designed to help people connect to all kinds of social services. Since these centers take calls from largely minority populations, our study formed a partnership with 2-1-1 call centers in the Houston area, the El Paso area, and the Lower Rio Grande Valley area of Texas, adding Cancer Control Navigation (CCN) intervention to the helpline’s existing services. We enrolled 1,736 callers, of whom 90% were ethnic and racial minorities.”

Detailed Look at the Service

She explained the service in more detail: “We received funding from the Cancer Prevention Research Institute of Texas to evaluate and develop an intervention that we called the Cancer Control Navigation. The crux of it is, [people call] for help, and the information specialist deals with the problem and asks them if they would be willing to answer some questions. If they say yes, we screen them for age and gender and ask them if they need any cancer control services, such as breast, cervical, or colon cancer screening; smoking cessation; or [human papillomavirus] vaccination for [themselves] or a child. If they were in need of a service, we would flag it, and the information specialist would give them a referral.”

Aims of the 2-1-1 Helpline Program

  • Develop and test a culturally appropriate cancer control navigation intervention in collaboration with 2-1-1 helplines in Texas
  • Deliver the Cancer Control Navigator intervention to Texans in need of services through the Gulf Coast and tip of Texas through 2-1-1 helplines
  • Determine the effectiveness and cost-effectiveness of this Cancer Control Navigation intervention

If the callers needed cancer-related health interventions, continued Dr. ­Fernandez, some callers were assigned to receive referrals, and others were assigned to receive referrals plus more detailed Cancer Control Navigation services. These services included access to a navigator who discussed the barriers patients faced in receiving health care; for example, the topics included negative attitudes about screening, lack of transportation, or difficulty taking time off from work—and suggestions for overcoming these barriers.

Dr. Fernandez noted that one of the study’s strengths was that it was designed and implemented in the real-world setting. “This type of collaborative effort with the 2-1-1 helpline has the potential to connect large numbers of underserved people to cancer control and prevention services and decrease the burden of cancer in poor, ethnic minorities and rural residents,” she revealed.

Key Findings

The study showed that the Cancer Control Navigation intervention increased the completion of any needed cancer control behavior by 21% compared with those who received only a referral. Considering individual behaviors, the Cancer Control Navigation intervention significantly increased Pap test screening by 53% compared with those who received a referral only.

Dr. Fernandez elaborated on these findings: “We tried to help people overcome motivational barriers, and quite often the navigator would talk with the person multiple times. We wanted to see if navigation helped people complete these cancer control services and if it was more beneficial than simply giving a person a referral to services. We found that while referrals were effective, there was a higher compliance rate to specific cancer services in those people who interacted with a navigator.”

Study Trend and Limitation

Several other cancer prevention behaviors were also higher in the Cancer Control Navigation group compared with the referral-only group, but Dr. Fernandez cautioned that these findings were not statistically significant, likely due to smaller sample sizes.

Texas Helpline for Health and Social Services

  • A nationally designated 3-digit telephone exchange (2-1-1) connected callers, largely minority populations, to health and social services within their community.
  • It is operated by state and local systems, often in partnership with local public or private agencies.
  • There are 2-1-1 systems in all 50 states; Washington, DC; and Puerto Rico, covering over 92% of the U.S. population.

Nevertheless, the trend of higher completion of cancer control behaviors among participants who received navigation was clear. For example, colorectal cancer screening increased by 40%, mammography increased by 17%, human papillomavirus vaccination of daughters increased by 43%, and participation in smoking cessation programs increased by 90%. 

Dr. Fernandez mentioned that the main limitation of the study was difficulty in following participants, as many used short-term cellphones and did not have phone numbers where they could be reached at later dates.

“The study results indicate there is a strong potential to reach the poor and the medically underserved with lifesaving cancer control services by partnering with existing programs aimed at helping them, such as the 2-1-1 helpline,” concluded Dr. Fernandez. ■

Disclosure: Dr. Fernandez reported no potential conflicts of interest.

Reference

1. Fernandez ME: Evaluation of the 2-1-1 Helpline Program to increase cancer control behaviors among underserved Texans. 9th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved. Abstract C49. Presented September 26, 2016.



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