Fresno Breast Cancer Navigator Pilot Project Susan Hughes, MS & John Zweifler, MD, MPH UCSF Fresno Family & Community Medicine John Capitman, Phd & Mathilda Ruwe, MD, MPH Central Valley Health Policy Institute Mary Wallace, MHA, FACHE San Joaquin Valley Health Consortium 41st STFM Annual Spring Conference May 4, 2008 Baltimore, MD

Acknowledgements A community-based participatory research pilot project funded in part by the California Breast Cancer Research Program Collaboration between CSU, Fresno Central Valley Health Policy Institute Community Medical Centers San Joaquin Valley Health Consortium UCSF Fresno Medical Education Program Family & Community Medicine Surgery

Problem Breast cancer diagnosis and care is a complicated process which may contribute to disparities in care and outcome A breast cancer navigator is one solution to overcoming barriers, but the optimal design has not been identified

Methods Chart review of (BI-RAD 4 and 5) patients Survivor interviews Consensus on where to focus navigator efforts between breast care providers researchers community advisors Pilot the navigation process for feasibility and patient acceptability

Variables Quantitative Qualitative Patient demographics Patient history Source of primary care Date of abnormal mammogram Date of diagnosis Pathology results Appointment dates Missed appointments Qualitative Demographics History Description of breast cancer experience Dealing with doctors Making appointments Keeping appointments Social support Problems

Mammography Results in 2006 at UMC

Demographics 69% Hispanic 50% prefer to speak Spanish 90% have public insurance 2% have one source of primary care 16% have a family history of breast cancer 33% have a co-morbidity

Survivors 12 interviews Mostly satisfied with care Communication Time Non-English speakers Medical terminology Process of care Sensitivity Time With provider for fuller explanations To grieve

Navigated 18 patients enrolled over 4 months 56% Hispanic 50% monolingual Spanish 12% missed appointments (historical rate: 16% for surgery & 28% for oncology) 112 Navigator interactions, average time spent In person Consent process - 27 minutes 1.2 meetings - 18 minutes per meeting On phone 2.6 successful calls – 5 minutes per call 2.1 unsuccessful calls – 1 minute per call

Next step Implement full navigator project Concentrate navigator efforts to reduce Percentage with undocumented diagnosis Time between abnormal finding and diagnosis Time between diagnosis and surgery (or beginning treatment)

Pilot results Feasible Patient acceptance Revise data collection to a minimum Patient acceptance Target patients with abnormal finding before diagnosis Navigator who can speak Spanish necessary

Conclusions Data missing Primary care is not coordinating care Need is present to ensure Information is exchanged between all care providers Missed appointments are followed up Patients understand where they are going and why

Questions? Susan Hughes, MS UCSF Fresno Family & Community Medicine shughes@fresno.ucsf.edu