BUSI 619 Week 8 Literature Review Presentation Example

Getting Patients From Abnormal to Answered: A Seven-Minute Presentation of a Literature Review on Patient Navigation

Slide 1: Abnormal Is Not Answered

• 4 in 10 patients wait more than three months for a diagnosis
• About 1 in 7 has no follow-up recorded after a year
• The question: would navigators close the gap?

Speaker notes: Good afternoon. When a screening test comes back abnormal, the patient's worry starts that day, but in our system, four in ten of those patients are still waiting for an answer three months later, and about one in seven never gets one on record. Over the past seven weeks I reviewed the research on one possible fix, patient navigation, and in the next few minutes I will tell you what it shows and what I think we should do.

Slide 2: The Question

• Patients: safety-net adults with an abnormal breast, cervical or colon screen
• Help: a patient navigator from result to diagnosis
• Compared with: our current letters and referrals
• Measured by: time to a diagnosis and share resolved in a year

Speaker notes: My question had four parts. Melnyk and Fineout-Overholt (2015) teach that a good question names the patients, the help being tested, what it is compared with and the result that matters, so each part became a search term. The result I cared about most was time, because time is what our patients lose.

Slide 3: How I Searched

• PubMed and CINAHL, adults, English
• 214 records screened, 48 read in full
• 12 primary studies kept, most of them randomized

Speaker notes: I searched two major databases and screened 214 records. I read 48 in full and kept 12 studies that reported original data on whether patients reached a diagnosis and how fast. Most were randomized trials, which is unusually strong evidence for a question about how care is organized.

Slide 4: Finding 1, the Benefit Comes Late

• No difference in the first three months
• A clear advantage from month four through month twelve
• Navigation rescues the patients who would drift away

Speaker notes: The first finding surprised me. In the national program's pooled analysis of more than ten thousand patients, navigation made no difference in the first 90 days, but from then until the end of the year, patients with a navigator reached a diagnosis at roughly half again the rate of patients without one (Freund et al., 2014). Trials in Ohio and Tampa showed the same delay. The patients who would have finished quickly did so anyway; navigation found the ones who would have been lost.

Slide 5: Finding 2, It Helps Most Where Life Is Hardest

• Biggest gains for people managing multiple illnesses
• Patients over 65 gained as much as younger ones
• Poverty, distance and insurance still slow care

Speaker notes: The second finding tells us where to start. Patients with several chronic illnesses waited longest and gained the most from navigation (Whitley et al., 2017). But navigation does not erase poverty: in Ohio, women in poorer neighborhoods still waited longer for an answer (Plascak et al., 2014). Navigators need help with rides and interpreters to reach those patients.

Slide 6: Finding 3, Reach Decides Results

• Phone-based navigation works in centralized programs
• One rural program offered navigators to fewer than 6 in 10 eligible patients
• Most patients can be reached within six calls

Speaker notes: The third finding is about delivery. Newer programs run navigation by phone from a central team, and it still helps, but in rural Oregon fewer than six in ten eligible patients were ever offered a navigator (Coronado et al., 2025). Another study found most patients answer within six call attempts (Gautom et al., 2024). A navigator who never reaches a patient cannot help that patient.

Slide 7: What the Evidence Cannot Tell Us

• No cost per patient resolved
• No follow-up long enough to see effects on cancer stage
• Most trials ran before today's phone and portal tools

Speaker notes: The gaps deserve a plain statement. None of the studies told us what navigation costs for each additional patient who reaches a diagnosis, none tracked patients far enough to learn whether cancers were caught earlier and most were done more than a decade ago. These gaps do not cancel the findings, but they are reasons to measure our own results carefully.

Slide 8: A Faith Perspective

• The woman who searched her house for one lost coin
• Every patient counted, not only the easy ones

Speaker notes: Jesus told of a woman who lit a lamp and swept her whole house to find one lost coin, then called her neighbors to celebrate when she found it (English Standard Version Bible, 2001/2016, Luke 15:8-10). The research tells us navigation's value lies in finding the few patients who would otherwise be lost. That is work worth doing carefully.

Slide 9: Three Recommendations

• Judge the program at twelve months, not three
• Start with patients who carry the heaviest burdens
• Track reach as closely as results, and fund rides and interpreters

Speaker notes: I recommend three things. First, evaluate the program over a full year so a slow start is not mistaken for failure. Second, give navigators first to the patients the studies say gain most: people juggling several illnesses, people over 65 and anyone with a record of missed visits. Third, keep a registry so every abnormal result is assigned and every call is counted, and set aside a small fund for transportation and interpreters.

Slide 10: The Decision Today

• Approve four navigators for a twelve-month pilot
• Report reach and time to diagnosis every quarter

Speaker notes: My request is that we approve four navigators for a twelve-month pilot in the clinics with the longest delays, with quarterly reports on reach and time to diagnosis. An abnormal result should end with an answer, and the evidence says navigators help more of our patients get one. Thank you. The references are on the final slide.

Slide 11: References

• Coronado et al. (2025); English Standard Version Bible (2016); Freund et al. (2014); Gautom et al. (2024); Melnyk and Fineout-Overholt (2015); Plascak et al. (2014); Whitley et al. (2017)

References

Coronado, G. D., Petrik, A. F., Leo, M. C., Coury, J., Durr, R., Badicke, B., Thompson, J. H., Edelmann, A. C., & Davis, M. M. (2025). Mailed outreach and patient navigation for colorectal cancer screening among rural Medicaid enrollees: A cluster randomized clinical trial. JAMA Network Open, 8(3), e250928. https://doi.org/10.1001/jamanetworkopen.2025.0928

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Freund, K. M., Battaglia, T. A., Calhoun, E., Darnell, J. S., Dudley, D. J., Fiscella, K., Hare, M. L., LaVerda, N., Lee, J., Levine, P., Murray, D. M., Patierno, S. R., Raich, P. C., Roetzheim, R. G., Simon, M., Snyder, F. R., Warren-Mears, V., Whitley, E. M., Winters, P., . . . Paskett, E. D. (2014). Impact of patient navigation on timely cancer care: The Patient Navigation Research Program. Journal of the National Cancer Institute, 106(6), dju115. https://doi.org/10.1093/jnci/dju115

Gautom, P., Rosales, A. G., Petrik, A. F., Thompson, J. H., Slaughter, M. T., Mosso, L., Hussain, S. A., Jimenez, R., & Coronado, G. D. (2024). Evaluating the reach of a patient navigation program for follow-up colonoscopy in a large federally qualified health center. Cancer Prevention Research, 17(7), 325-333. https://doi.org/10.1158/1940-6207.CAPR-23-0498

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing and healthcare: A guide to best practice (3rd ed.). Wolters Kluwer.

Plascak, J. J., Llanos, A. A., Pennell, M. L., Weier, R. C., & Paskett, E. D. (2014). Neighborhood factors associated with time to resolution following an abnormal breast or cervical cancer screening test. Cancer Epidemiology, Biomarkers & Prevention, 23(12), 2819-2828. https://doi.org/10.1158/1055-9965.EPI-14-0348

Whitley, E. M., Raich, P. C., Dudley, D. J., Freund, K. M., Paskett, E. D., Patierno, S. R., Simon, M., Warren-Mears, V., & Snyder, F. R. (2017). Relation of comorbidities and patient navigation with the time to diagnostic resolution after abnormal cancer screening. Cancer, 123(2), 312-318. https://doi.org/10.1002/cncr.30316