Title

Effect of a navigation program on patient return after an abnormal clinical breast cancer screening examination finding at Aga khan University Hospital, Nairobi

Date of Award

2015

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Prof. Ronald Wasike

Second Supervisor/Advisor

Prof. Hassan Saidi

Department

General Surgery (East Africa)

Abstract

Background: Breast cancer screening programs have been developed in few developing countries to aid curb the increasing burden. However, breast cancer is still being detected in late stage, attributed to barriers in health care. Patient navigation programs have been implemented in developed countries to help patients overcome these barriers, and they have been associated with early detection and timely diagnosis. In Aga Khan University Hospital, only 23% of patients with an abnormal clinical breast examination finding after breast cancer screening subsequently present for review by a surgeon. We aim to investigate the effect of a navigation program on patient return after an abnormal clinical breast examination finding.

Methodology: A prospective interventional study comparing two groups of patients with an abnormal breast clinical breast examination finding after breast cancer screening done ‘before’(control group) and ‘after’(intervention group)the introduction of patient navigation program. Patients in the before group received standard care prior to introduction of the navigation program, the after group were navigated. Seventy-six patients were recruited into the study over six months with 38 in each arm. They were followed up for thirty days. Time to return was recorded in days; timely return was defined as review within fourteen days, delayed return as review between fifteen and thirty days and defaulters as no review within thirty days.

Results: The proportion of return in the non-navigated and navigated group was 23.7% and 57.9% respectively (OR 4.8, [95% CI 1.62-14.41] p =0.0018.)The proportion of timely return in the non-navigated and navigated group was 18.4% and 52.6% respectively. The mean time to return in the non-navigated and navigated group was 7.33 days and 8.33 days respectively (p=0.67).

Conclusion: There was an increase in the proportion of return after abnormal clinical breast examination finding after implementation of the breast navigation program at Aga Khan University Hospital, Nairobi. screening examination finding at Aga khan University Hospital, Nairobi

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