Findings from the Studies “Patient Navigation for CRC Screening with Low-Income Minorities” and “Enhanced Patient Navigation for Screening Colonoscopy in East Harlem Residents”

Contact Name: 
Lina Jandorf
Publication Author(s): 
Lina Jandorf and colleagues (see studies linked, below)
Category: 
Patient Navigation
Subcategory: 
Barriers to Care Access
Target Population: 
Adult
Black or African American
Hispanic or Latino
Medicaid Beneficiaries
Medicare Beneficiaries
Older Adult
Cancer Site: 
Colorectal
Setting Description: 

Participants were recruited from a resident-driven primary care practice within an ambulatory teaching hospital.

Project Description: 

[Note: This summary synthesizes findings from two studies, one focused on screening colonoscopy (SC) among Black men and women (n=411), and the other focused on SC among Hispanic/Latino men and women (n=461).]

These studies compared the effects of different types of patient navigation (PN) on completion of screening colonoscopy (SC). Patients were recruited through referral by their primary care providers and enrolled following confirmation of medical eligibility by a gastroenterology nurse (e.g. average risk of colorectal cancer; lack of contraindications to sedation). Participants were randomized to standard and culturally-targeted PN groups; participants in one study were also randomized to culturally-targeted PN with professional PNs or peer PNs who had previously completed SC. All participants received three PN phone calls (a scheduling call, a call two weeks before their colonoscopy date, and a call three days prior to the procedure) scripted to their PN group, and written instructions (mailed) for bowel preparation. All forms of PN demonstrated high rates of SC completion, with a rate of 75.7% completion among Black participants and 80% completion among Hispanic/Latino participants. PN-guided SC completion rates in these studies were 15% above the national average for Black participants and 30% among primary care provider referral SC completion rates for Hispanics/Latinos. These results suggest that patient navigation, no matter what type, is successful in generating adherence with The U.S. Preventive Services Task Force (USPSTF)’s guidelines on CRC screening. Subsequent analyses of the data also demonstrated that patient navigation is a cost-effective way to increase patient adherence with SC, resulting in both early detection and treatment of CRC or pre-cancerous polyps and institutional revenue.

Significance of Findings: 

PN can increase adherence with SC, a priority of the USPSTF and other national groups. Because colon cancer is preventable via the removal of pre-cancerous polyps, PN for CRC screening has the potential to reduce colorectal cancer incidence, suffering, and death. PN may also be valuable to encourage patient adherence with other screening tests that have low utilization rates due to a variety of barriers to care, including patient unfamiliarity with the test or fear that a diagnosis is death sentence. PN may be particularly valuable for helping patients understand new screening guidelines and tests, for example the recent recommendation to screen long-term smokers for lung cancer using low dose computed tomography (LDCT).

Key Takeaways or Implications for Patients or Caregivers: 
Patients and caregivers should ask questions about SC. PN seems to be an excellent way to ensure completion of SC.
Key Takeaways for Practice: 
PN is a cost-effective way to increase patient adherence with primary care providers’ referrals to SC. PN may also be useful for other screening test such as low dose computed tomography (LDCT) for lung cancer screening.
Opportunities for Future Research or Takeaways for Other Researchers: 
Research in the colorectal cancer field should examine the dose effect of PN on SC (e.g. how much navigation is needed, and by whom) in order to better predict the population’s screening needs.
Patient, Caregiver and/or Communities Research Engagement: 
The research team has a very active, long-term community advisory board members, who provided feedback on study materials and helped with recruitment and engagement of patients. Patient and community engagement contributed to a study enrollment response rate of over 90% among potential study participants.
Funder: 

This research was funded by NIH grant #5R25CA132692-03 and internal funding from the Icahn School of Medicine at Mount Sinai.

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