A Culturally Tailored Navigator Program for Colorectal Cancer Screening in a Community Health Center: A Randomized, Controlled Trial
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Minority racial/ethnic groups have low colorectal cancer (CRC) screening rates.
To evaluate a culturally tailored intervention to increase CRC screening, primarily using colonoscopy, among low income and non-English speaking patients.
Randomized controlled trial conducted from January to October of 2007.
Single, urban community health center serving a low-income, ethnically diverse population.
A total of 1,223 patients 52-79 years of age overdue for CRC screening, randomized to intervention (n = 409) vs. usual care control (n = 814) groups.
Intervention patients received an introductory letter with educational material followed by phone or in-person contact by a language-concordant “navigator.” Navigators (n = 5) were community health workers trained to identify and address patient-reported barriers to CRC screening. Individually tailored interventions included patient education, procedure scheduling, translation and explanation of bowel preparation, and help with transportation and insurance coverage. Rates of colorectal cancer screening were assessed for intervention and usual care control patients.
Over a 9-month period, intervention patients were more likely to undergo CRC screening than control patients (27% vs. 12% for any CRC screening, p < 0.001; 21% vs. 10% for colonoscopy completion, p < 0.001). The higher screening rate resulted in the identification of 10.5 polyps per 100 patients in the intervention group vs. 6.8 in the control group (p = 0.04).
Patients were from one health center. Some patients may have obtained CRC screening outside our system.
A culturally tailored, language-concordant navigator program designed to identify and overcome barriers to colorectal cancer screening can significantly improve colonoscopy rates for low income, ethnically and linguistically diverse patients.
ClinicalTrials.gov registration number: NCT00476970
KEY WORDScolon cancer screening colonoscopy patient navigation randomized control trial
The authors thank the staff from Clinical Research Program and Community Benefits Program at Massachusetts General Hospital. The paper was presented at the Annual Meeting of the Society of General Medicine in Pittsburg, PA, on April 10, 2008. The study was funded by: Clinical Innovation Award through the Massachusetts General Hospital, Community Benefits Program at Massachusetts General Hospital, Jane’s Trust, Massachusetts Cancer Prevention Community Research Network, and a grant for the Massachusetts General Primary Care Practice-Based Research Network (NCI 1CA121908).
Conflict of Interest
- 1.American Cancer Society, Cancer Facts and Figures 2006. 2006, American Cancer Society: Atlanta, GA.Google Scholar
- 9.Hoffman-Goetz L, Breen N, Meissner H. The impact of social class on the use of cancer screening within three racial/ethnic groups in the United States. Ethn & Dis. 1998;8(1):43–51.Google Scholar
- 14.Haas JS, Earle CC, Orav JE, Brawarsky P, Neville BA, Williams DR. Racial segregation and disparities in cancer stage for seniors. J Gen Intern Med, 2008.Google Scholar
- 18.Holmes-Rovner M, Williams GA, Hoppough S, Quillan L, Butler R, Given CW. Colorectal cancer screening barriers in persons with low income. Cancer Practice: A Multidisciplinary Journal of Cancer Care. 2002;10(5):240–7.Google Scholar
- 22.Green AR, Peters-Lewis A, Percac-Lima S, et al. Barriers to screening colonoscopy for low-income latino and white patients in an urban community health center. J Gen Intern Med. 2008;In Press.Google Scholar
- 24.Smedley BD, Stith AY, Nelson AR. Unequal treatment confronting racial and ethnic disarities in health care. 2003, Washington, DC: The National Academies Press.Google Scholar
- 38.Chen LA, Santos S, Jandorf L, et al. A program to enhance completion of screening colonoscopy among urban minorities. Clin Gastroenterol Hepatol, 2008.Google Scholar
- 44.US Preventive Services Task Forces, The Guide to Clinical Preventive Services. 2006, Agency for Healthcare Research and Quality: Rockville, MD.Google Scholar