A patient navigation initiative to improve access to breast cancer care in Cali, Colombia.

BACKGROUND: Patient navigation is the logistical and emotional support necessary to achieve diagnostic and treatment compliance. It can improve time to diagnosis, initiation of treatment, and patient satisfaction, as well as reduce the cost of treatment. Colombia has a well-defined Cancer Control Plan, but its implementation is lacking. AIM: To implement the first patient navigation initiative in Colombia, as part of a pilot program for the early detection of breast cancer. METHODS: The process involved assessing and addressing the barriers faced by women to access breast health care by providing training for health personnel, strengthening primary health care providers, and coordinating diverse level institutions for the provision of services. This led to the design and implementation of a navigation strategy focused on the needs of patients in Cali, Colombia and the involvement of the local health system to provide such services. RESULTS: Time to diagnosis was significantly reduced; research advanced by the Colombian National Institute of Cancerology shows that the average time between the first medical consultation and diagnosis was 91 days (CI 95%: 82-97 days), while this study carried out the same process in an average of 30 days, but patients still had issues with continuity of treatment due to financial strain between healthcare providers and insurers. Navigation, however, manages to overcome many of these problems by assisting women in the clinical and administrative care processes and seeking well-being for the beneficiaries. In addition, patient navigation helped identify critical failures in care, such as fragmentation of care and excessive bureaucracy. The navigation process improved data collection and established agreements to simplify and make the delivery of care more efficient. In addition, it generated partnerships between service providers and insurers. CONCLUSION: While several barriers and poor understanding of the navigation process still exist, a navigation program can help implement a Cancer Control Plan.

Mobile Applications: Breaking Barriers to Early Breast and Cervical Cancer Detection in Underserved Communities.

BACKGROUND: Although potentially curable with early detection and timely treatment, breast cancer (BC) and cervical cancer (CC) remain leading causes of death for Colombian women. Lack of education, complicated administrative processes, and geographic limitations hinder early cancer detection. Today, technological tools permeate the society and could assess user risk, deliver customized information, and provide care coordination. We evaluated the effectiveness of a free mobile application (mApp) to reach women, understand misconceptions, identify users at risk for BC and/or CC, and coordinate screening tests in Cali, Colombia. METHODS: The mApp was developed and advertised in four healthcare facility waiting rooms. It used educational, evaluative, and risk factor questions followed by brief explanations to assess the population's knowledge, educate on BC and/or CC, and identify users in need of screening test(s). Women who required screening were navigated and enrolled in the national cancer program. RESULTS: From August 2017 to August 2019, 1,043 women downloaded the mApp. BC misconceptions included beliefs that BC can be prevented (87%), obesity does not increase the risk of BC (49%), and deodorant causes BC (17%). CC misconceptions included that pap smears should not be performed while sexually active (64%), vaginal pain is an early sign of CC (44%), and only women contract human papilloma virus (33%). Overall, 29% (303) were identified as at risk and needed a screening test, with 32% (98) successfully screened. DISCUSSION: mApps can identify women at risk for BC and/or CC, detect barriers to early cancer detection, and help coordinate screening test(s). This technology has widespread applications and may be useful in other underserved communities.

Overcoming Barriers in the Implementation of Programs for Breast and Cervical Cancers in Cali, Colombia: A Pilot Model.

Breast and cervical cancers are leading causes of mortality among women in Latin America. Colombia has universal health care and a government-sponsored 10-year cancer control plan focused on prevention, early detection, and treatment. However, many administrative and social barriers have hindered its success, and a majority of patients are diagnosed at a late stage. Established in 2012, Partners for Cancer Care and Prevention (PFCCAP) works to decrease the burden of these cancers by mitigating the obstacles women face during their cancer diagnosis and treatment. Through community outreach meetings with medical personnel, hospital directors, and government officials, PFCCAP identified major barriers, including lack of trained health care personnel, few centers with adequate screening equipment, and a fragmented health system with significant administrative delays and poor continuity of care. Its solution included monthly teleconferences, biannual on-site training, quality control programs, and improved access to screening equipment. PFCCAP also initiated a patient navigation project. After implementation of the PFCCAP plan of action, from 2012 to 2018, the average time from initial consult to biopsy decreased from 65 to 20 days; from biopsy to diagnosis, 33 to 4 days; and from diagnosis to surgery, 121 to 60 days. To date, more than 1,500 women have benefited from this initiative, which has expanded to other regions. Overall, PFCCAP is creating centers of excellence in strategically located hospitals and promoting the implementation of national guidelines. Although several barriers still exist, PFCCAP is helping to implement an efficient health care model that can be replicated in other underserved populations.