Skip to main content

Advertisement

SpringerLink
Log in

Effect of patient navigation on colorectal cancer screening in a community-based randomized controlled trial of urban African American adults

  • Original Paper
  • Published:
Cancer Causes & Control Aims and scope Submit manuscript

Abstract

Purpose

In recent years, colorectal cancer (CRC) screening rates have increased steadily in the USA, though racial and ethnic disparities persist. In a community-based randomized controlled trial, we investigated the effect of patient navigation on increasing CRC screening adherence among older African Americans.

Methods

Participants in the Cancer Prevention and Treatment Demonstration were randomized to either the control group, receiving only printed educational materials (PEM), or the intervention arm where they were assigned a patient navigator in addition to PEM. Navigators assisted participants with identifying and overcoming screening barriers. Logistic regression analyses were used to assess the effect of patient navigation on CRC screening adherence. Up-to-date with screening was defined as self-reported receipt of colonoscopy/sigmoidoscopy in the previous 10 years or fecal occult blood testing (FOBT) in the year prior to the exit interview.

Results

Compared with controls, the intervention group was more likely to report being up-to-date with CRC screening at the exit interview (OR 1.55, 95 % CI 1.07–2.23), after adjusting for select demographics. When examining the screening modalities separately, the patient navigator increased screening for colonoscopy/sigmoidoscopy (OR 1.53, 95 % CI 1.07–2.19), but not FOBT screening. Analyses of moderation revealed stronger effects of navigation among participants 65–69 years and those with an adequate health literacy level.

Conclusions

In a population of older African Americans adults, patient navigation was effective in increasing the likelihood of CRC screening. However, more intensive navigation may be necessary for adults over 70 years and individuals with low literacy levels.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Society AC (2013) Cancer facts and figures 2013. American Cancer Society, Atlanta

    Google Scholar 

  2. Dimou A, Syrigos KN, Saif MW (2009) Disparities in colorectal cancer in African-Americans vs Whites: before and after diagnosis. World J Gastroenterol 15:3734–3743

    Article  PubMed Central  PubMed  Google Scholar 

  3. Wallace K, Hill EG, Lewin DN et al (2013) Racial disparities in advanced-stage colorectal cancer survival. Cancer Causes Control 24:463–471

    Article  PubMed Central  PubMed  Google Scholar 

  4. Cavicchia PP, Adams SA, Steck SE et al (2013) Racial disparities in colorectal cancer incidence by type 2 diabetes mellitus status. Cancer Causes Control 24:277–285

    Article  PubMed Central  PubMed  Google Scholar 

  5. Doubeni CA, Major JM, Laiyemo AO et al (2012) Contribution of behavioral risk factors and obesity to socioeconomic differences in colorectal cancer incidence. J Natl Cancer Inst 104:1353–1362

    Article  PubMed Central  PubMed  Google Scholar 

  6. Niu X, Roche LM, Pawlish KS, Henry KA (2013) Cancer survival disparities by health insurance status. Cancer Med 2:403–411

    Article  PubMed Central  PubMed  Google Scholar 

  7. Burgess DJ, van Ryn M, Grill J et al (2011) Presence and correlates of racial disparities in adherence to colorectal cancer screening guidelines. J Gen Intern Med 26:251–258

    Article  PubMed Central  PubMed  Google Scholar 

  8. Douglas JB, Silverman DT, Pollak MN, Tao Y, Soliman AS, Stolzenberg-Solomon RZ (2010) Serum IGF-I, IGF-II, IGFBP-3, and IGF-I/IGFBP-3 molar ratio and risk of pancreatic cancer in the prostate, lung, colorectal, and ovarian cancer screening trial. Cancer Epidemiol Biomarkers Prev 19:2298–2306

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Schroy PC 3rd, Coe A, Chen CA, O’Brien MJ, Heeren TC (2013) Prevalence of advanced colorectal neoplasia in white and black patients undergoing screening colonoscopy in a safety-net hospital. Ann Intern Med 159:13–20

    Article  PubMed Central  PubMed  Google Scholar 

  10. Henley SJ, King JB, German RR, Richardson LC, Plescia M (2010) Surveillance of screening-detected cancers (colon and rectum, breast, and cervix)—United States, 2004–2006. MMWR Surveill Summ 59:1–25

    PubMed  Google Scholar 

  11. Freeman HP (2006) Patient navigation: a community based strategy to reduce cancer disparities. J Urban Health 83:139–141

    Article  PubMed Central  PubMed  Google Scholar 

  12. Chen LA, Santos S, Jandorf L et al (2008) A program to enhance completion of screening colonoscopy among urban minorities. Clin Gastroenterol Hepatol 6:443–450

    Article  PubMed  Google Scholar 

  13. Christie J, Itzkowitz S, Lihau-Nkanza I, Castillo A, Redd W, Jandorf L (2008) A randomized controlled trial using patient navigation to increase colonoscopy screening among low-income minorities. J Natl Med Assoc 100:278–284

    PubMed  Google Scholar 

  14. Jandorf L, Gutierrez Y, Lopez J, Christie J, Itzkowitz SH (2005) Use of a patient navigator to increase colorectal cancer screening in an urban neighborhood health clinic. J Urban Health 82:216–224

    Article  PubMed Central  PubMed  Google Scholar 

  15. Lasser KE, Murillo J, Medlin E et al (2009) A multilevel intervention to promote colorectal cancer screening among community health center patients: results of a pilot study. BMC Fam Pract 10:37

    Article  PubMed Central  PubMed  Google Scholar 

  16. Percac-Lima S, Grant RW, Green AR et al (2009) A culturally tailored navigator program for colorectal cancer screening in a community health center: a randomized, controlled trial. J Gen Intern Med 24:211–217

    Article  PubMed Central  PubMed  Google Scholar 

  17. Whitlock EP, Lin JS, Liles E, Bell TL, Fu R (2008) Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 149: 627–637

  18. Bass PF 3rd, Wilson JF, Griffith CH (2003) A shortened instrument for literacy screening. J Gen Intern Med 18:1036–1038

    Article  PubMed Central  PubMed  Google Scholar 

  19. Lippman SA, Shade SB, Hubbard AE (2010) Inverse probability weighting in sexually transmitted infection/human immunodeficiency virus prevention research: methods for evaluating social and community interventions. Sex Transm Dis 37:512–518

    PubMed Central  PubMed  Google Scholar 

  20. Kobayashi LC, Wardle J, von Wagner C (2014) Limited health literacy is a barrier to colorectal cancer screening in England: evidence from the English Longitudinal Study of Ageing. Prev Med 61:100–105

  21. Martinez-Donate AP, Halverson J, Simon NJ et al (2013) Identifying health literacy and health system navigation needs among rural cancer patients: findings from the Rural Oncology Literacy Enhancement Study (ROLES). J Cancer Educ 28:573–581

    Article  PubMed Central  PubMed  Google Scholar 

  22. Wilson EA, Wolf MS, Curtis LM et al (2010) Literacy, cognitive ability, and the retention of health-related information about colorectal cancer screening. J Health Commun 15(Suppl 2):116–125

    Article  PubMed  Google Scholar 

  23. Dinh TA, Alperin P, Walter LC, Smith R (2012) Impact of comorbidity on colorectal cancer screening cost-effectiveness study in diabetic populations. J Gen Intern Med 27:730–738

    Article  PubMed Central  PubMed  Google Scholar 

  24. Ferrante JM, Ohman-Strickland P, Hudson SV, Hahn KA, Scott JG, Crabtree BF (2006) Colorectal cancer screening among obese versus non-obese patients in primary care practices. Cancer Detect Prev 30:459–465

    Article  PubMed Central  PubMed  Google Scholar 

  25. Hendren S, Chin N, Fisher S et al (2011) Patients’ barriers to receipt of cancer care, and factors associated with needing more assistance from a patient navigator. J Natl Med Assoc 103:701–710

    PubMed Central  PubMed  Google Scholar 

  26. Martinez KA, Pollack CE, Phelan DF et al (2013) Gender differences in correlates of colorectal cancer screening among black medicare beneficiaries in Baltimore. Cancer Epidemiol Biomarkers Prev 22:1037–1042

    Article  PubMed Central  PubMed  Google Scholar 

  27. Wong RK, Wong ML, Chan YH, Feng Z, Wai CT, Yeoh KG (2013) Gender differences in predictors of colorectal cancer screening uptake: a national cross sectional study based on the health belief model. BMC Public Health 13:677

    Article  PubMed Central  PubMed  Google Scholar 

  28. Chen J, Shao J (2000) Nearest neighbor imputation for survey data. J Off Stat 16:113–131

    CAS  Google Scholar 

  29. Horton WS, Spieler DH (2007) Age-related differences in communication and audience design. Psychol Aging 22:281–290

    Article  PubMed  Google Scholar 

  30. Jefferson L, Bloor K, Birks Y, Hewitt C, Bland M (2013) Effect of physicians’ gender on communication and consultation length: a systematic review and meta-analysis. J Health Serv Res Policy 18:242–248

    Article  PubMed  Google Scholar 

  31. Law J, Rush R, Parsons S, Schoon I (2013) The relationship between gender, receptive vocabulary, and literacy from school entry through to adulthood. Int J Speech Lang Pathol 15:407–415

    Article  PubMed  Google Scholar 

  32. Weiss BD, Reed RL, Kligman EW (1995) Literacy skills and communication methods of low-income older persons. Patient Educ Couns 25:109–119

    Article  CAS  PubMed  Google Scholar 

  33. StataCorp (2009) Stata Statistical Software: Release 11. StataCorp LP, College Station

    Google Scholar 

  34. Joseph D, King J, Miller J, Richardson L (2010) Prevalence of colorectal cancer screening among adults—behavioral risk factor surveillance system, United States, 2010. Morb Mortal Wkly Rep Suppl 61:51–56

    Google Scholar 

  35. Zapka JM, Klabunde CN, Arora NK, Yuan G, Smith JL, Kobrin SC (2011) Physicians’ colorectal cancer screening discussion and recommendation patterns. Cancer Epidemiol Biomarkers Prev 20:509–521

    Article  PubMed Central  PubMed  Google Scholar 

  36. Naylor K, Ward J, Polite BN (2012) Interventions to improve care related to colorectal cancer among racial and ethnic minorities: a systematic review. J Gen Intern Med 27:1033–1046

    Article  PubMed Central  PubMed  Google Scholar 

  37. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383

    Article  CAS  PubMed  Google Scholar 

  38. Elixhauser A, Steiner C, Harris DR, Coffey RM (1998) Comorbidity measures for use with administrative data. Med Care 36:8–27

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank the Cancer Prevention and Treatment Demonstration participants, staff, and Community Advisory Committee. This work was supported by the Cancer Prevention and Treatment Demonstration for Ethnic and Racial Minorities of the Centers for Medicare and Medicaid Services (Cooperative Agreement #1A0CMS300066), the Community Networks Program (Grant U54CA153710) of the National Cancer Institute, the Maryland Cigarette Restitution Fund. In addition, Dr. M. A. Garza was supported, in part, through her Mentored Research Scientist Development Award to Promote Diversity (K01CA140358).

Conflict of interest

J.G. Ford is a consultant/advisory board member of GSK. The remaining authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA

    Hisani N. Horne

  2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Darcy F. Phelan-Emrick, Craig E. Pollack & Diane Markakis

  3. Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Craig E. Pollack

  4. Department of Oncology, Department of Acute and Chronic Care, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Jennifer Wenzel

  5. Johns Hopkins University School of Nursing, Baltimore, MD, USA

    Jennifer Wenzel

  6. Department of Population, Family and Reproductive Health and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Saifuddin Ahmed

  7. Department of Behavioral and Community Health, School of Public Health, University of Maryland College Park, College Park, MD, USA

    Mary A. Garza

  8. Health Partners Cancer Program and Institute for Education and Research, Minneapolis, MN, USA

    Gary R. Shapiro

  9. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Lee R. Bone

  10. Park West Health Systems, Baltimore, MD, USA

    Lawrence B. Johnson

  11. The Brooklyn Hospital Center, Brooklyn, NY, USA

    Jean G. Ford

  12. National Institutes of Health/NCI/DCEG/HREB, 9609 Medical Center Drive, Rm 7E234, MSC 7234, Bethesda, MD, 20892-7234, USA

    Hisani N. Horne

Authors
  1. Hisani N. Horne
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Darcy F. Phelan-Emrick
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Craig E. Pollack
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Diane Markakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jennifer Wenzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Saifuddin Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mary A. Garza
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gary R. Shapiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Lee R. Bone
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Lawrence B. Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jean G. Ford
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hisani N. Horne.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 59 kb)

Supplementary material 2 (PDF 54 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Horne, H.N., Phelan-Emrick, D.F., Pollack, C.E. et al. Effect of patient navigation on colorectal cancer screening in a community-based randomized controlled trial of urban African American adults. Cancer Causes Control 26, 239–246 (2015). https://doi.org/10.1007/s10552-014-0505-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10552-014-0505-0

Keywords

Search

Navigation