YESHIVA UNIVERSITY
Grant: $258,085 - National Institutes of Health - Sep. 1, 2009
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Award Description: DESCRIPTION (provided by applicant): Patient navigation (PN) is a widely used intervention approach in initiatives to reduce cancer health disparities and facilitate access to care, particularly in African American (AA) populations. However, the results of PN vary and little is known about the elements that make PN effective. Furthermore, resources for navigator training are limited and unstandardized. Such knowledge is critically important as PN is a widely accepted and used clinical tool and the patient navigator workforce is expected to undergo tremendous growth as a result of the Patient Navigator Outreach and Chronic Disease Prevention Act, recently passed legislation. One compelling area for investigation is the quality of communication within navigation encounters. Effective communication is essential to a navigator's efforts to identify the full range of barriers to healthcare a patient faces and to develop feasible strategies to overcome these barriers. Guided by Communication Accommodation Theory, the proposed research will focus on patient-centered and empathic communication with the goal of identifying concrete verbal behaviors associated with effective PN. The goal of the proposed research will be achieved through collaboration with a funded R01 parent study that is investigating the impact of PN on adherence to colonoscopy referral among AA primary care patients (R01- CA120658). The parent study includes a randomized clinical trial comparing two telephone-based navigation arms: 1) patient navigation conducted by a peer-lay navigator who is matched to the patient's age and has had a recent screening colonoscopy and 2) navigation conducted by a degreed health professional. The proposed R21 study will randomly select 220 audiotapes of these navigation encounters stratified on two variables: patients' actual adherence to colonoscopy referral (yes vs. no) and type of navigator (peer vs. professional). The audiotapes will then be analyzed using two complementary coding schemes: the Roter Interaction Analysis System and the Empathic Communication Coding System. The specific aims of this proposed research are 1) to examine the effect of patient-centered and empathic communication within patient navigation encounters on adherence to colonoscopy referral among AA primary care patients, and 2) to investigate differences between peer and professional navigators in terms of their patient-centered and empathic communication exchanges with AA primary care patients referred for colonoscopy. Results will yield data on key communication strategies that can be translated into disseminable and evidence-based training modules to enhance existing navigator training curricula. Such training can increase the effectiveness of new navigators who may have limited experience interacting with AA patients in the context of a cancer screening intervention, as well as those who are continuing in the relatively new and rapidly growing and evolving area of PN. Although the focus of the proposed research is PN, results are likely to be generalizable beyond PN and should provide insight for health education and promotion in general.
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