Linking physicians and patients is a major undertaking, but given the ubiquity of smartphone technology and the rise in app development, the healthcare industry is poised to leverage advances in [ Read More ]
May 2016 VOL 7, NO 4
A Feasibility Study of a Virtual Navigation Program for Low-Income Breast Cancer Patients
Kathy J. Helzlsouer; Susan E. Appling; Susan Scarvalone; Shannon Manocheh; Ryan MacDonald; Lisa Gallicchio; Dawn Henninger; Arti P. Varanasi
Background: Socioeconomic disparities negatively impact completion of adjuvant breast cancer treatment. Navigation programs may improve treatment completion but may not be accessible to all patients, especially in low-resource communities.
Objective: A randomized trial was conducted to determine the feasibility of a web-based navigation program to improve adjuvant breast cancer treatment completion among low-income patients.
Methods: Patients (N = 101) were recruited and randomized to either information access only (comparison arm) or to the web-based navigation program with nurse/social worker support (intervention arm), and were given a netbook computer, training, and Internet access. Adherence to recommended chemotherapy, radiation therapy, and/or initiation of hormone therapy was assessed by medical record review (available for 48 patients on each study arm). Baseline characteristics and results were compared by study arm using t test, chi-square, Fisher’s exact test, and Poisson regression analyses.
Results: The majority of participants were unemployed or on disability (68%) and were nonwhite (67%). Those randomized to the intervention had lower education levels and were slightly older than those on the comparison arm (P = .04). Two patients on the intervention arm refused part or all of recommended treatments, and 6 patients on the comparison arm refused some or all recommended treatments (Padj = .08).
Discussion: Treatment completion was improved with navigator interaction compared with information access alone, but the difference was not statistically significant. Absolute benefit compared with usual care should be evaluated in a randomized trial.
Conclusion: Centralized virtual navigation is feasible for low-income populations and has the potential to improve treatment completion.
The case study for this discussion highlights the complexities of care coordination when patients arrive unprepared physically or mentally for the recommended medical treatments as determined by guidelines. It also [ Read More ]