Tuesday, July 3, 2012

Patient navigation programs are making a difference in the lives of female refugees and immigrants

Cancer navigator Diane Maldonado
consults with patients in culturally-
tailored navigator program for breast
cancer screening


When it comes to cancer screening, refugee and immigrant women are particularly vulnerable populations due to their life circumstances in their former country and the lack of health care access after they resettle in a new country. Many do not speak English, and never had cancer screening prior to coming to the US. Cultural barriers interfere with preventive cancer screening. They might be embarrassed about the procedure, and they have an acute fear of a cancer diagnosis.

MGH Chelsea HealthCare Center serves more than 800 refugees and immigrants from Bosnia and other former Yugoslavian countries. An analysis of preventive cancer care at MGH Chelsea revealed that women speaking Serbo-Croatian had lower mammography rates (44%) as compared to English- (65%) and Spanish- (65.5%) speaking patients. With support from the Susan G. Komen Foundation, Dr. Sanja Percac-Lima launched a culturally-tailored navigator program for breast cancer screening for Serbo-Croatian- speaking women refugees and immigrants.

“We recruited a young bi-lingual college-educated woman from the former Yugoslavia as the patient navigator. She received extensive training in breast cancer prevention, treatment and patient navigation. She worked with the social worker/training coordinator learning how to develop trusting relationships with patients and how to use motivational interviewing techniques to connect with and coach them. She learned to schedule and to provide support at the patients’ mammogram appointments,” Dr. Percac-Lima said.

Jelena, the current patient navigator, describes her work. “All my contacts with patients are in their native language. I talk with the women about preventive care and the importance of routine mammograms. I explore each patient’s specific barriers to screening and help them get a mammogram,” she said.

Often the process of convincing a patient to go for a mammogram takes several phone calls of encouragement, reassurances, calming fears, and stressing the importance of taking care of their own and their families’ health. To further reach out to women, the patient navigator makes home visits and organizes breast health education group sessions in community settings where women support each other about getting their mammograms.

Jelena tailors interventions to individual patients’ needs to ease the process of undergoing screening. She helps scheduling appointments, makes reminder calls, arranges transportation, resolves insurance issues and/or accompanies patients who are afraid or feel unable to navigate the mammogram appointment on their own. As part of this intervention, culturally appropriate educational materials in Serbo-Croatian were developed with input and feedback from the women.

Dr. Percac-Lima was pleased with the results. “Using these approaches, patient navigation improved the mammography rates in refugees and immigrants from the former Yugoslavia. Women responded favorably to the intensive attention given them by the navigator who shared their culture and language and whose sincerity and genuineness helped form trusting relationships. During only one year with this program, MGH Chelsea clinicians were able to raise screening rates from 44% to 67%, and eliminate the disparity that existed between these women and English- and Spanish-speaking patients at the health center,” she said.

As a result of the program’s success, the patient navigator program at MGH Chelsea now also serves female refugees and immigrants from the Middle East and Somalia.

* Funding provided by the Massachusetts Affiliate of Susan G. Komen for the Cure

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