Having a bilingual (English and Serbo-Croatian) patient navigator to address patient-reported barriers to breast screening significantly increased the mammography rate for women refugees and immigrants from Bosnia and other former Yugoslav states, a new study reports.
Patient navigators, who are able to answer questions in the cultural context of a minority group, were introduced in 1990 to improve cancer care among black women in New York's Harlem section. Subsequently, this concept has been successfully used to improve cancer prevention, diagnosis, and treatment in other disadvantaged populations. This is particularly true for immigrant populations who often do not speak English, have experienced the trauma of war, and have not had cancer screening before coming to the United States.
The researchers recruited a young, bilingual college-educated woman from former Yugoslavia to be trained as a patient navigator for Serbo-Croatian refugee and immigrant women treated at Massachusetts General Hospital's Chelsea HealthCare Center (MGH Chelsea). These women had a lower mammography rate (44 percent) than English-speaking (65 percent) and Spanish-speaking (66 percent) women. MGH Chelsea had 91 women patients who self-identified as speakers of Serbo-Croatian and were eligible for breast cancer screening (ages 40 to 79 years old). At the beginning of the study, 40 of these women had received a mammogram in the past year. After 1 year of followup and intervention by the Serbo-Croatian-speaking patient navigator, 61 patients (67 percent) had been screened within the past year.
The numbers of those who were 1 year or more overdue, or who had never been screened, declined 29–50 percent by the end of the study. Educational level (high school or beyond) was associated with being up-to-date with mammography by the end of the study, but age, marital status, religion, insurance status, or number of years receiving care at MGH Chelsea were not.
The study was funded in part by AHRQ (HS19161). More details are in "Patient navigation to improve breast cancer screening in Bosnian refugees and immigrants," by Sanja Percac-Lima, M.D., Bosiljka Milosavljevic, M.D., Sarah Abernethy Oo, M.S.W., and others in the August 2012 Journal of Immigrant and Minority Health 14(4), pp. 727-730.