Patient navigation to increase colorectal cancer screening among Latino Medicare enrollees: a randomized controlled trial
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Latino Medicare enrollees report suboptimal rates of colorectal cancer screening (CRCS) despite Medicare policies designed to improve CRCS access for older persons. Patient navigation (PN) may address many underlying barriers to CRCS, yet little is known about the effectiveness of PN to increase CRCS adherence among Latino Medicare enrollees.
Using a randomized controlled trial study design, we evaluated tailored PN delivered outside of primary care settings as an intervention to increase CRCS adherence in this population. Intervention participants (n = 135) received tailored PN services which included education, counseling, and logistical support administered in their language of choice. Comparison participants (n = 168) received mailed cancer education materials. We compared CRCS rates between interventions and used multivariable logistic regression to assess the odds of CRCS adherence for PN versus comparison groups after adjusting for covariates of interest.
More navigated than non-navigated participants became CRCS adherent during the study period (43.7 vs. 32.1 %, p = 0.04). The odds of CRCS adherence were significantly higher for PN relative to comparison participants before and after adjusting for covariates (unadjusted OR 1.64, p = 0.04; adjusted OR 1.82, p = 0.02). Higher CRCS adherence rates were observed primarily in the uptake of endoscopic screening methods.
This study demonstrates that PN delivered outside of the primary care environment is modestly effective in increasing CRCS adherence among Latino Medicare enrollees. This intervention strategy should be further evaluated as a complement to primary care-based PN and other care coordination strategies to increase adherence with CRCS and other evidence-based screenings among older Latinos.
KeywordsPatient navigation Colorectal cancer screening Latinos Medicare enrollees Health disparities
This project was supported by the Centers for Medicare and Medicaid Services (1-0CNS300065-01), the National Institute on Minority Health and Health Disparities (P60 MD000503) and the MD Anderson Cancer Center (CA016672). At the time the study was conducted, KRE was at The University of Texas and supported by the Kellogg Health Scholars Program (P0117943 from the W.K. Kellogg Foundation to the Center for Advancing Health) and the National Cancer Institute (2R25CA57712). ITV was supported in part by the National Cancer Institute (5K01CA151785-04). MH was supported in part by the National Cancer Institute (P30 CA016672).
Conflict of interest
The authors declare that they have no conflict of interest.
The study protocol was approved by the Institutional Review Board of The University of Texas MD Anderson Cancer Center.
- 2.Calonge N, Petitti DB, DeWitt TG et al (2008) Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 149:627–637Google Scholar
- 3.Siegel R, Cokkinides V, Jemal A (2012) Cancer facts & figures for Hispanics/Latinos 2012–2014. American Cancer Society, AtlantaGoogle Scholar
- 4.Joseph D, King J, Miller J et al (2012) Prevalence of colorectal cancer screening among adults—behavioral risk factor surveillance system, United States, 2010. Morb Mortal Wkly Rep 61:51–56Google Scholar
- 28.Mitchell J, Bir A, Hoover S et al (2012) Evaluation of the cancer prevention and treatment demonstration for ethnic and racial minorities. Final report to Congress. RTI International, Waltham, p 83Google Scholar
- 29.Calhoun EA, Whitley EM, Esparza A et al (2010) A national patient navigator training program. Health Promot Pract 11:205–215 Google Scholar
- 30.Hispanic or Latino Population. Minority Health 2013 [cited 2013 April 29]. http://www.cdc.gov/minorityhealth/populations/REMP/hispanic.html