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Reducing Barriers to Breast Cancer Care Through Avon Patient Navigation Programs

Stanley, Sandte MPH, CHES; Arriola, Kimberly Jacob PhD, MPH; Smith, Shakiyla MPH; Hurlbert, Marc PhD; Ricci, Carolyn BA; Escoffery, Cam PhD, MPH, CHES

Journal of Public Health Management and Practice: September/October 2013 - Volume 19 - Issue 5 - p 461–467
doi: 10.1097/PHH.0b013e318276e272
Original Articles

Context: Avon Foundation for Women grantees provide breast cancer services through patient navigation (PN) in an effort to alleviate barriers to care among underserved women.

Objective: To gain a better understanding of how PN programs function, this study explores variations in the use of navigators, types of services offered, description of clients they serve, tracking of treatment completion, and evaluation mechanisms.

Participants: Fifty-six Avon PN programs funded since 2008 throughout the United States were contacted.

Design: An online survey was distributed to the grantees of which 44 (81%) complete responses were collected and analyzed.

Results: Clients were racially and ethnically diverse, mostly in the 40- to 64-year old age range (64%) and 91.6% with an average income of less than $30 000. Women were either uninsured (50.7%) or receiving Medicaid (32.4%). PN programs were both community and hospital-based (22.5%); many hospitals (35.2%) were described as safety nets (eg, provide a significant level of care to low-income, uninsured, vulnerable populations). On-site services included breast screening (eg, mammography and breast ultrasound) and treatment (eg, breast surgery and radiation therapy). Some barriers to care identified by the programs included transportation, access to appointments, language, and financial issues (eg, cost of screening and treatment specifically for those uninsured). More than 39% of programs provided care across the cancer continuum.

Conclusions: Many Avon PN programs incorporated navigation services that span the cancer care continuum. They addressed disparities by offering navigation and on-site medical services to reduce multiple systems barriers and social issues related to breast care.

This study explores variations in the use of navigators, types of services offered, description of clients served, tracking of treatment completion, and evaluation mechanisms to gain a better understanding of how patient navigation programs function.

Centers for Disease Control and Prevention (Ms Stanley), Emory Center for Injury Control (Ms Smith), Emory University (Ms Stanley and Drs Jacob Arriola and Escoffery), Atlanta, Georgia; and Avon Foundation for Women (Ms Ricci and Dr Hurlbert), New York, New York.

Correspondence: Sandte Stanley, MPH, CHES, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-07, Atlanta, GA 30333 (

The authors acknowledge all of the Avon grantees who participated in the study and the Avon Foundation for Women for allowing them to conduct this study.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Disclosure: The authors declare no conflicts of interest.

© 2013 Lippincott Williams & Wilkins, Inc.