Table 1 General characteristics of the studies included
From: Economic evaluation of patient navigation programs in colorectal cancer care, a systematic review
| Authors | Target population | Cancer type and navigation continuum phase | Navigator profile | Study design | Time horizon |
|---|---|---|---|---|---|
| Donaldson (2012) | 959 breast cancer and 411 colorectal cancer patients; African American, White, Hispanic and other race; Low-income/ underserved populations. |
Breast, Colorectal Screening to diagnostic resolution |
Characteristics: lay patient navigator (Washington, DC); non-clinically licensed patient navigator (Kentucky); non-clinically licensed patient navigator, nurse-LPN, bilingual outreach worker (Louisiana) Tasks: Unspecified | 2 arms among 3 community hospitals: comparison between usual care (1), PN program (2) | 12 months |
| Elkin (2012) | 25,481 low-income, high risk, urban, majority Hispanic |
Colorectal To Screening |
Characteristics: Lay health educators Tasks: 1. appointment reminders; 2. colonoscopy and bowel preparation education; 3. management of patient concerns; 4. referral to financial services | Quasi-experimental with pre-post; 2 arms (3 intervention and 3 comparison hospitals); usual care (1), PN program (2) |
Pre-program period: 12 months Post-program period: 1 month |
| Jandorf (2013) |
Socioeconomically disadvantaged 700 patients referred for colonoscopy by primary care providers between May 2008–May 2010, age 50+, due for colorectal screening (colonoscopy > 5 years, not up to date with other forms of screening) |
Colorectal To Screening |
Health worker Characteristics: 3 types of navigators were used due to objectives for a different study using same patient population: 1. Professional navigators with formal health education training, African American race concordant; 2. Peer navigators (“lay” individuals > 50 years old from East Harlem who had undergone colonoscopy) with study-provided training, African American race concordant; 3. Professional navigators, language concordant but not necessarily race concordant for non-African American patients Tasks: 1. Appointment scheduling; 2. Patient education on colonoscopy procedure and preparation; 3. Appointment reminder calls (multiple); 4. Transportation needs assessment; 5. Confirmation that mailed information was received; 6. Concerns addressed; 7. Depending on study arm, script about importance of colorectal cancer screening, discussion of navigator’s colonoscopy experience, and/or impact of colorectal cancer on African Americans. |
RCT Single-arm (4 navigation arms for separate RCT study were aggregated and not compared in this study) | 24 months |
| Bensink (2014) | 10,521 patients with breast, prostate, colorectal or cervical cancer screening abnormalities (5063 navigated, 5458 usual care). Mostly minority (39% Hispanic, 32% African American), 40% publically insured adult population. |
Breast, Prostate, Colorectal, Cervical Screening to diagnostic resolution |
Characteristics: Professional health workers and/or lay persons Tasks: 1. “support and guidance for timely access to the cancer care system,” 2. “addressing barriers,” 3. “facilitating quality care.” | Research designs varied among sites: Individually RCT (2 sites); Group RCT (2 sites); Quasi-experimental (5 sites) | 12 months |
| Ladabaum (2015) | Hypothetical cohort of 10,000 adults (43% African American, 49% Hispanic, 4% white, 4% other) entered into model at age 50 and followed until age 100 or death |
Colorectal To Screening |
Characteristics: Unspecified Tasks: Unspecified | Comparison between (1) usual care (2) PN program (3) Fecal occult blood test or fecal immunochemical test. | Life time |
| Lairson (2014) | 945 patients age 50–79 noncompliant with USPSTF colorectal cancer screening recommendations, with visit at participating practice in the last 2 years), mostly White |
Colorectal To Screening |
Characteristics: Nurse navigator Tasks: 1. Structured follow up call to confirm receipt of mailed CRC screening materials and to answer questions; 2. Reassessment of screening preference; 3. Encourage screening completion; 4. Provide instructions for stool blood test or identify colonoscopy locations (no appointment scheduling); 5. Provision of additional information if screening preference changed. | RCT, pre-post, 3 arms (usual care; mailed information and referral phone number; mailed information and nurse navigator follow up) | 12 months |
| Blakely (2015) | Stage III colon cancer patients |
Colorectal Diagnosis through Treatment and End of Life |
Characteristics: hospital-based clinical nurse specialist Tasks: 1. “providing information and support for the patient,” 2. “identifying and addressing patient barriers to accessing care (transport/ financial/ social)”, 3. “coordinating arrangements for pre-operative assessments and hospital admission,” 4. “optimising post-operative care,” 5. “Tracking investigations and appointments,” 6. “ensuring the patient is discussed at a multidisciplinary team meeting,” 7. “Making referrals as necessary,” 8. “acting on any administrative delays.” | Comparison between (1) Usual care; (2) PN program. | Lifetime after diagnosis |
| Meenan (2015) | Patients due for colorectal screening (colonoscopy > 9 years, sigmoidoscopy > 4 years, fecal occult blood test > 9 months) |
Colorectal To Screening |
Characteristics: 2 part-time nurse navigators (combined 10% full-time equivalent weekly) Tasks: 1. assistance with colorectal screening decision-making; 2. follow up on fecal occult blood tests with no laboratory results after 3 weeks; 3. assessment of colorectal cancer risk; 4. review of procedural risk; 5. motivational counseling to define patient screening intent; 6. creation of patient-shared screening action plan; 7. referrals assistance; 8. appointment assistance; 9. endoscopy preparation assistance; 10. test completion tracking. | RCT, 4 arms: (1) usual care; (2) automated electronic health record-linked mailings; (3) automated mailing with telephone assistance; (4) automated mailing, telephone assistance, and nurse navigation services | 24 months |
| Wilson (2015) | 461 Hispanic men, low-income, uninsured, 50+ years old, member of Bexar County’s financial assistance program, with no colorectal cancer screening in the last 10 years. |
Colorectal To Screening |
Characteristics: Bilingual community health worker, Bilingual program coordinator Tasks: 1. colorectal cancer and colonoscopy patient education; 2. discussions on colorectal cancer with immediate family; 3. liaison between Hispanic communities and patient care services; 4. encouragement of colonoscopy appointment scheduling; 5. addressing questions and concerns throughout process, 6. home visits as needed, 7.transportation assistance, 8. Social support, 9. Appointment coordination and scheduling, 10. Setup of appointment reminders. | Comparison between (1) Usual care, (2) PN program. | 24 months |