October 2016 VOL 7, NO 9
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Do Patient Navigators Improve Cancer Care Utilization Behaviors? A Meta-Analysis
Sobia Ali-Faisal, PhD1; Tracey J. F. Colella, RN, PhD2; Naomi Medina-Jaudes1; Lisa Benz Scott, PhD3
1Stony Brook University, Stony Brook, NY; 2Toronto Rehab/University Health Network; 3Stony Brook University Health Sciences Center, Stony Brook, NY
Objectives: Patient navigation (PN) interventions are increasingly used in cancer care research and practice with unclear results regarding their effectiveness. Meta-analyses are a powerful tool to determine the effectiveness of interventions. To date, there are no published meta- analyses on PN studies. The purpose of this meta-analysis was to review the empirical evidence regarding PN effects on cancer care–related behavioral outcomes.
Methods: Medline, Embase, HealthSTAR, Cochrane Library, PsycINFO, CINAHL, and Joanna Briggs Institute databases were systematically searched for randomized controlled trials focused on PN (from 1989 to 2015). Two authors screened titles and abstracts and assessed full-text articles based on predefined inclusion/exclusion criteria. One author and 1 research assistant extracted data and conducted quality assessments using the Downs and Black (1998) scoring tool. Analyses were conducted for 3 behavioral outcome categories: performance of recommended health screenings, completion of diagnostic-related behaviors, and attending cancer care follow-up treatment. Effect estimates were pooled using odds ratios, and 95% confidence intervals were calculated through random effects models. The meta-analysis was completed using Review Manager software.
Results: The search identified 3985 articles, of which 20 were included in this analysis focusing on cancer care outcomes. Compared with usual care, patients (n = 13) who received PN interventions were significantly more likely to access cancer screening (OR 2.48; 95% CI, 1.92-3.21; P <.00001). PN was favored to increase adherence to cancer care follow-up treatment (n = 4) and obtaining a cancer diagnoses (n = 3). Most studies involved trained lay navigators (n = 9) compared with health professionals (eg, nurses; n = 7).
Conclusions: This meta-analysis demonstrated that, when compared with usual care, PN interventions are almost 2.5 times more effective in improving the likelihood that individuals will complete recommended cancer screening behaviors and show promise in increasing behaviors leading to diagnostic resolution and completing cancer care follow-up treatment. Although the limitations of this review must be considered, the results suggest that PN is an intervention that can be effective for improving health behavior outcomes in a cancer care context. Future research is warranted to test navigation interventions in a variety of healthcare and community-based settings.
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