Background: Interventions aimed at improving access to timely cancer care for patients in low- and middle-income countries (LMIC) are urgently needed. We aimed to evaluate a patient navigation (PN) program to reduce referral time to cancer centers for underserved patients with a suspicion or diagnosis of cancer at a public general hospital in Mexico City.
Materials and methods: From January 2016 to March 2017, consecutive patients aged >18 years with a suspicion or diagnosis of cancer seen at Ajusco Medio General Hospital in Mexico City who required referral to a specialized center for diagnosis or treatment were enrolled. A patient navigator assisted patients with scheduling, completing paperwork, obtaining results in a timely manner, transportation, and addressing other barriers to care. The primary outcome was the proportion of patients who obtained a specialized consultation at a cancer center within the first 3 months after enrollment.
Results: Seventy patients (median age 54, range 19-85) participated in this study. Ninety-six percent (n = 67) identified >1 barrier to cancer care access. The most commonly reported barriers to health care access were financial burden (n = 50) and fear (n = 37). Median time to referral was 7 days (range 0-49), and time to specialist appointment was 27 days (range 1-97). Ninety-one percent of patients successfully obtained appointments at cancer centers in <3 months.
Conclusion: Implementing PN in LMIC is feasible, and may lead to shortened referral times for specialized cancer care by helping overcome barriers to health care access among underserved patients.
Implications for practice: A patient navigation program for patients with suspicion or diagnosis of cancer in a second-level hospital was feasible and acceptable. It reduced patient-reported barriers, and referral time to specialized appointments and treatment initiation were within international recommended limits. Patient navigation may improve access to care for underserved patients in developing countries.
摘要
背景。中低收入国家 (LMIC) 的患者迫切需要旨在帮助其及时获得癌症医护服务的干预措施。我们旨在评估患者导航 (PN) 计划，以减少在墨西哥城公立综合医院将疑似患癌或确诊患癌且无法享受周到服务的患者转至癌症中心的转诊时间。
材料和方法。本研究连续招募了自 2016 年 1 月至 2017 年 3 月期间在墨西哥城 Ajusco Medio 综合医院看诊的疑似患癌或确诊患癌且需要转诊至专科中心进行诊断或治疗的年龄 >18 岁的患者。患者导航员协助患者制定日程安排、完成文书工作、及时获取结果、转运以及处理医护方面的其他障碍。主要结果为在加入研究后的前 3 个月内在癌症中心获得专业化咨询的患者的比例。
结果。70 名患者(中位年龄为 54 岁，范围介于 19–85 岁之间)参加了本次研究。96% 的患者 (n = 67) 确认了 >1 项获取癌症医护服务的障碍。在获取医护服务方面，最常报告的障碍为经济负担 (n = 50) 和害怕 (n = 37)。转诊的中位时间为 7 天(范围介于 0–49 天)，专家预约的时间为 27 天(范围介于 1–97 天)。91% 的患者在 3 个月内可以在癌症中心成功获得预约。
结论。在 LMIC 施行 PN 是切实可行的，通过帮助无法享受周到服务的患者克服获取医护服务方面的各种障碍，可以缩短将患者转至专科癌症医护设施的转诊时间。
《肿瘤学家》
实践意义:针对二级医院中疑似患癌或确诊患癌患者的患者导航计划是切实可行且大受欢迎的。它可以减少患者报告的障碍，而且，专科预约的转诊时间和治疗开始时间均在国际建议的界限之内。患者导航可以帮助发展中国家无法享受周到服务的患者获得更多的医护服务。
Keywords: Cancer care facilities; Developing countries; Early cancer detection; Patient navigation; Referral.
© AlphaMed Press 2018.