Term of Award

Fall 2017

Degree Name

Doctor of Public Health in Public Health Leadership (Dr.P.H.)

Document Type and Release Option

Dissertation (restricted to Georgia Southern)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Jiann-Ping Hsu College of Public Health

Committee Chair

Yelena Tarasenko

Committee Member 1

Hani Samawi

Committee Member 2

Stuart Tedders

Committee Member 3

Jill Johns

Committee Member 3 Email



The purpose of this study was to examine differences in time from breast cancer diagnostic resolution to initial treatment among female patients who received Patient navigation (PN) services compared to those who did not. The study population consisted of 1338 female breast cancer patients, over the age of 18 at large health system in the Metro Atlanta area. Differences in time to the first treatment were analyzed using the accelerated failure time log-logistic models. Final model was chosen using forward selection algorithm for variable selection and included navigation status and stage of diagnosis as independent variables. Variables considered for inclusion in the final model were patient’s age, race and ethnicity, marital status, stage of disease at diagnosis, census tract Federal Poverty Level, and rural/urban county designation. In unadjusted analyses, women aged 41-50 years had a longer time from diagnostic resolution to treatment by a factor of 1.18 (95% CI: 1.03 – 1.36) than women aged over 80 years (p-value = 0.03). Non-Hispanic black patients had a longer time from breast cancer diagnostic resolution to treatment initiation by a factor of 1.11 (95% CI: 1.03 – 1.20) compared to non-Hispanic white women (p-value = 0.01). There were no statistically significant differences in time from diagnostic resolution to treatment by other patient characteristics in unadjusted analyses. Based on stratified analyses, the only significant difference in time to treatment was observed among patients with stage II breast cancer diagnosis. These women who did not receive PN had a shorter time from diagnostic resolution to treatment by a factor of 0.86 (95% CI: 0.76 – 0.97) compared to navigated women with stage II breast cancer diagnosis (p-value = 0.01). No statistically significant differences by navigation status were observed among patients with stages 0, I, III, and IV diagnoses. While the gold standard for measuring the PN efficacy has consistently been time from abnormal finding to diagnostic resolution, future research on other measures, including those based on qualitative or mixed-methods studies, of the PN efficacy is warranted.

Research Data and Supplementary Material