Cancer Causes & Control

, Volume 26, Issue 9, pp 1351–1359 | Cite as

Patient navigation to increase colorectal cancer screening among Latino Medicare enrollees: a randomized controlled trial

  • K. R. Enard
  • L. Nevarez
  • M. Hernandez
  • S. R. Hovick
  • M. R. Moguel
  • R. A. Hajek
  • C. E. Blinka
  • L. A. Jones
  • I. Torres-Vigil
Brief report

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Patient navigation Colorectal cancer screening Latinos Medicare enrollees Health disparities 

Notes

Acknowledgments

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.

Ethical standard

The study protocol was approved by the Institutional Review Board of The University of Texas MD Anderson Cancer Center.

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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • K. R. Enard
    • 1
  • L. Nevarez
    • 2
  • M. Hernandez
    • 3
  • S. R. Hovick
    • 4
  • M. R. Moguel
    • 5
  • R. A. Hajek
    • 6
  • C. E. Blinka
    • 7
  • L. A. Jones
    • 8
  • I. Torres-Vigil
    • 9
    • 10
  1. 1.Department of Health Management and PolicySaint Louis UniversitySaint LouisUSA
  2. 2.Department of Social Work - College of Public PolicyThe University of Texas at San AntonioSan AntonioUSA
  3. 3.Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.School of CommunicationThe Ohio State UniversityColumbusUSA
  5. 5.Department of Palliative, Rehabilitation, and Integrative MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA
  6. 6.Center for Health Equity and Evaluation Research, Division of Cancer Prevention and Population SciencesThe University of Texas MD Anderson Cancer CenterHoustonUSA
  7. 7.The University of Texas MD Anderson Cancer CenterHoustonUSA
  8. 8.College of NursingPrairie View A&M UniversityHoustonUSA
  9. 9.Graduate College of Social WorkUniversity of HoustonHoustonUSA
  10. 10.Department of Palliative, Rehabilitation, and Integrative MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

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