Assessing patient navigation as a tool to address equity in cancer early detection

BACKGROUND: The Louisiana Breast and Cervical Health Program (LBCHP) provides breast and cervical cancer screenings at no cost to about 5,000 low-income women per year. LBCHP was designed to increase access to cancer screenings for low-income women, a traditionally underserved population. A main program component is the provision of patient navigation services. Patient navigation provides extra layers of patient-centered education and resources to assist with screening completion. Both rural and racial/ethnic minority populations are underserved and have benefited from patient navigation. The purpose of this study was to establish estimates of LBCHP’s eligible population and to measure the effect of patient navigation in reducing racial/ethnic and geographic (e.g., rural) inequities in cancer early detection. METHODS: This study analyzed program data from patients who received navigation services resulting in cervical and breast cancer screenings between July 01, 2016 and June 30, 2018. We used the combination of U.S. Census Bureau’s Small Area Health Insurance Estimates 2016 and the American Community Survey 2017 to calculate the number of eligible women by race/ethnicity and by parish (county). We used the 2010 Census to estimate the distribution of the rural population by city and parish. Using patient addresses, residences were categorized into urban, suburban and rural. RESULTS: The population of women ages 21–64 years in Louisiana is 1.3 million and almost half (46.7%) live at or under 250% of the federal poverty level (FPL). The poverty rate is much higher among LBCHP’s racial/ethnic minorities: 65.1% among Blacks and 58.5% among Latinx as compared to 35.5% among Whites. To be racially/ethnically equitable, LBCHP would aim to have the following client distribution: at least 47% Black and 5% Latinx. The population LBCHP served was 47% Black and 18% Latinx. While 27% of Louisiana is rural, only 17% of LBCHP’s women served are from rural areas. In contrast, 61% of the state is urban, while 72% of LBCHP’s women served live in urban areas. LBCHP’s clients had excellent follow-up rates after abnormal screening test results with well over 95% of all racial/ethnic groups having completed follow-up. Latinxs had a higher percentage of abnormal results than Blacks and Whites. CONCLUSIONS: This study showed that LBCHP is achieving racial/ethnic equity in the client population that is served through patient navigation with LBCHP’s largest reach among the Latinx population. In addition, once clients receive screening, they have excellent follow-up rates for any abnormalities. Because LBCHP’s program goals include serving a high number of women, an unintended consequence is that LBCHP’s rural population is underserved.