Cambridge, MA...A new study has found that targeting patient navigation to black and non-English speaking patients may be one approach to reducing disparities in colorectal cancer (CRC) screening. The findings appear in the May 23 issue of the Archives of Internal Medicine.
Colorectal cancer, the second leading cause of cancer death in the U.S., is preventable through screening. Nevertheless, about 40 percent of eligible adults in the U.S. and more foreign-born U.S. residents are overdue for CRC screening. Patients at greatest risk of not being screened include minorities, patients with Medicaid or no health insurance, those who are foreign-born, and patients of low socioeconomic status.
The new study links the implementation of patient navigators to improved screening rates. Patient navigators are non-clinical staff members who guide patients through the health care system so that they receive appropriate services. The navigators perform a wide range of advocacy and coordination activities, such as assisting patients in obtaining health insurance or transportation to appointments.
The study was conducted at Cambridge Health Alliance (CHA), a public healthcare system that serves the communities of Cambridge, Somerville, and Boston's metro-north region. Researchers from CHA, Boston University School of Medicine, Harvard Medical School, and Harvard School of Public Health identified 465 primary care patients from four community health centers and two public hospital-based clinics who were not up-to-date with CRC screening and spoke English, Haitian Creole, Portuguese, or Spanish.
The researchers randomly allocated patients to receive a patient navigation-based intervention or usual care. Intervention patients received an introductory letter from their primary care provider with educational material followed by telephone calls from a language-concordant navigator. The navigators offered patients the option of being screened by fecal occult blood testing or colonoscopy. The primary outcome was completion of any CRC screening within 12 months. Secondary outcomes included the proportions of patients screened by colonoscopy and who had adenomas or cancer detected.
Over a 12 month period, the researchers found that intervention patients were more likely to undergo CRC screening than control patients (33.6 percent vs. 20.0 percent), to be screened by colonoscopy (26.4 percent vs. 13.0 percent), and to have adenomas detected (8.1 percent vs. 3.9 percent).
"Patient navigation increased CRC screening rates substantially among ethnically and linguistically diverse patients served by urban community health centers and public hospital-based clinics," said lead author Karen Lasser, MD, MPH, who currently serves as an associate professor of medicine and public health at BUSM and Boston University School of Public Health and an internal medicine physician at Boston Medical Center.
Focusing patient navigation on populations of black and non-English speaking patients may be a particularly effective approach to reducing CRC screening disparities for these patients. Future research should assess how health systems can sustain this benefit when patient navigation is implemented as a routine component of primary care.
Funding for this study was provided by a Mentored Research Scholar Grant from the American Cancer Society.