Opt-Out Patient Navigation to Improve Breast and Cervical Cancer Screening Among Homeless Women

Background: A patient navigation model was implemented to improve breast and cervical cancer screening among women who were homeless in five shelters and shelter clinics in New York City in 2014. Materials and Methods: Navigation consisted of opt-out screening to eligible women; cancer health and screening education; scheduling and following up for screening completion, obtaining, and communicating results to patients and providers; and care coordination with social services organizations. Results: Women (n = 162, aged 21-74, 58% black) completed mammogram (88%) and Pap testing (83%) from baselines of 59% and 50%, respectively. There was no association between mental health or substance abuse and screening completion. Adjusted analysis showed a significant association between refusing/missing Pap testing and older age (odds ratio [ OR] 1.12, 95% confidence interval [ CI] 1.04-1.20); independent predictors of mammogram included more pregnancies (OR 0.57, 95% CI 0.37-0.88) and older age (OR 0.84, 95% CI 0.79-0.90). Conclusions: Opt-out patient navigation is feasible and effective and may mitigate multilevel barriers to cancer screening among women with unstable housing.