Lina Jandorf Mount Sinai School of Medicine New York City Bridging the Health Care Divide
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Transcript of Lina Jandorf Mount Sinai School of Medicine New York City Bridging the Health Care Divide
The Impact of Navigation The Impact of Navigation Services for Breast and Cervical Services for Breast and Cervical Cancer Screening for Spanish-Cancer Screening for Spanish-
speaking Immigrant Latinasspeaking Immigrant Latinas
Lina Jandorf Lina Jandorf Mount Sinai School of Medicine Mount Sinai School of Medicine
New York CityNew York CityBridging the Health Care DivideBridging the Health Care Divide
April 19, 2007April 19, 2007
Co-AuthorsCo-Authors
LeaVonne Pulley - University of Arkansas for LeaVonne Pulley - University of Arkansas for Medical SciencesMedical Sciences
Michelle Trevino - University of Arkansas for Medical Michelle Trevino - University of Arkansas for Medical SciencesSciences
Luisa Feliciano – Mount Sinai School of MedicineLuisa Feliciano – Mount Sinai School of MedicineDeborah Erwin – Roswell Park Cancer InstituteDeborah Erwin – Roswell Park Cancer Institute
Topics to be Covered TodayTopics to be Covered Today
Latinas in the United StatesLatinas in the United States
Breast CancerBreast Cancer
Esperanza y VidaEsperanza y Vida
Where we are goingWhere we are going
Latinas in the United StatesLatinas in the United States
Fastest growing immigrant group in the USFastest growing immigrant group in the US
Over 20 different countries of OriginOver 20 different countries of Origin
Different Methods of ImmigrationDifferent Methods of Immigration– Puerto RicanPuerto Rican– MexicanMexican– DominicansDominicans
Breast Cancer and LatinasBreast Cancer and Latinas
Most common cancer among LatinasMost common cancer among Latinas– Lower incidence compared to White womenLower incidence compared to White women
Diagnosed at later stage Diagnosed at later stage – More metastatic diseaseMore metastatic disease
Lower rates of screeningLower rates of screening– E.g. Mammography use is lowerE.g. Mammography use is lower
Even greater for recent immigrantsEven greater for recent immigrants
Reasons for Underutilization of Reasons for Underutilization of ScreeningScreening
Access to CareAccess to Care– Insurance Insurance – Immigration StatusImmigration Status
AcculturationAcculturation
LanguageLanguage
Fatalistic BeliefsFatalistic Beliefs
FearFear– Both of finding cancer and deportationBoth of finding cancer and deportation
Esperanza y VidaEsperanza y Vida
““Familias Saludables Empiezan con Mujeres Familias Saludables Empiezan con Mujeres Saludables”Saludables”
““Healthy Families begin with Healthy Healthy Families begin with Healthy Women”Women”
Study DesignStudy Design
Educational ProgramsEducational Programs– Rural / Urban sitesRural / Urban sites– New York City and ArkansasNew York City and Arkansas
Two study conditionsTwo study conditions– Breast and Cervical Cancer ScreeningBreast and Cervical Cancer Screening– DiabetesDiabetes
Pre and Post Test KnowledgePre and Post Test Knowledge
2-Month Follow Up Telephone Call2-Month Follow Up Telephone Call
Patient NavigationPatient Navigation
Program ComponentsProgram Components
Role ModelRole Model– Breast Cancer SurvivorBreast Cancer Survivor– Living well with DiabetesLiving well with Diabetes
Lay Health EducatorsLay Health Educators– FactsFacts– Screening GuidelinesScreening Guidelines– Risk FactorsRisk Factors
Key Program ElementsKey Program ElementsFaith based programFaith based program
Family, including extended familyFamily, including extended family
Address Medical MistrustAddress Medical Mistrust
Address FatalismAddress Fatalism
Address Access to CareAddress Access to Care
FindingsFindings
Program conducted November 2005 Program conducted November 2005 through November 2006through November 200665 Programs Completed65 Programs Completed– 35 in Arkansas and 30 in NYC35 in Arkansas and 30 in NYC– 40 on Cancer and 25 on Diabetes40 on Cancer and 25 on Diabetes
653 Participants – Per program653 Participants – Per program– 11.3 (0.2) overall (range of 2 to 50)11.3 (0.2) overall (range of 2 to 50)
8.1 (6.6) Females8.1 (6.6) Females3.2 (4.3) Men3.2 (4.3) Men
FindingsFindingsCountry of OriginCountry of Origin Years in the Years in the
USUSRangeRange
Mexico (51% of Mexico (51% of sample)sample)
8.3 (6.3)8.3 (6.3) LT 6 months – LT 6 months – 64 years64 years
Dominican Republic Dominican Republic (12%)(12%)
17.4 (9.7)17.4 (9.7) LT 6 months – LT 6 months – 35 years35 years
Puerto Rico (7%)Puerto Rico (7%) 30.6 (12.9)30.6 (12.9) 2-53 years2-53 years
Central America Central America (13%)(13%)
11.7 (8.5)11.7 (8.5) 1-35 years1-35 years
South America (11%)South America (11%) 14.8 (11.5)14.8 (11.5) 1-40 years1-40 years
Pre/Post Knowledge at BaselinePre/Post Knowledge at Baseline
Pre ScorePre Score Post ScorePost Score
Diabetes Diabetes KnowledgeKnowledge
39.0439.04
42.4042.40
81.4881.48
46.7746.77
Cervical Cancer Cervical Cancer KnowledgeKnowledge
52.0152.01
58.6458.64
56.3356.33
76.8876.88
Breast Cancer Breast Cancer KnowledgeKnowledge
44.4444.44
46.7746.77
47.5347.53
72.1972.19
1st line = Diabetes Programs
2nd line = Cancer Programs
2 Month Follow Up Data2 Month Follow Up Data
235 Women235 Women
– 119 Under 40119 Under 40– 98 40 Plus98 40 Plus– 18 Missing Age18 Missing Age
Cancer ScreeningCancer Screening
Diabetes Diabetes ProgramProgram
Cancer Cancer ProgramProgram
Clinical Breast Clinical Breast ExamExam
48% completed 48% completed at follow upat follow up
83%83%
MammographyMammography
(women 40 plus)(women 40 plus)
78%78% 83%83%
Breast Self ExamBreast Self Exam 50%50% 88%88%
Pap ExamPap Exam 39%39% 71%71%
Refers to women who were non-adherent at baseline
ImplicationsImplications
Use of navigatorsUse of navigators– BilingualBilingual– From the communityFrom the community
How to sustain these increases?How to sustain these increases?
How to increase reach of the programs?How to increase reach of the programs?
Future DirectionsFuture Directions
What are the factors related to the What are the factors related to the baseline screening ratesbaseline screening rates– Knowledge pre programKnowledge pre program– Country of OriginCountry of Origin– AgeAge– Years in the USYears in the US
Future DirectionsFuture Directions
What predicts who gets screened within 2 What predicts who gets screened within 2 months?months?– Knowledge post programKnowledge post program– Country of OriginCountry of Origin– AgeAge– Years in the USYears in the US– Marital StatusMarital Status– Partner at ProgramPartner at Program
AcknowledgementsAcknowledgements
National Susan G. Komen Breast Cancer National Susan G. Komen Breast Cancer Foundation –Grants #POP 0201290 and Foundation –Grants #POP 0201290 and #POP 0503950#POP 0503950
Mount Sinai School of MedicineMount Sinai School of Medicine
University of Arkansas Medical CenterUniversity of Arkansas Medical Center
Our Communities!Our Communities!