1. 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, Baltimore, MD

2. 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

3. 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

4. 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

5. 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

6. Mammography Results in 2006 at UMC

7. 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

9. 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

10. 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

11. 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)

12. 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

13. 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

14. Questions? Susan Hughes, MS UCSF Fresno Family & Community Medicine