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

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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.

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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.

Author information

Authors and Affiliations

  1. Department of Health Management and Policy, Saint Louis University, 3545 Lafayette Ave, Room 380, Saint Louis, MO, 63104, USA

    K. R. Enard

  2. Department of Social Work - College of Public Policy, The University of Texas at San Antonio, 501 Cesar Chavez, San Antonio, TX, 78207, USA

    L. Nevarez

  3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 462, Houston, TX, 77030, USA

    M. Hernandez

  4. School of Communication, The Ohio State University, 154 North Oval Mall, Columbus, OH, 43210, USA

    S. R. Hovick

  5. Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 462, Houston, TX, 77030, USA

    M. R. Moguel

  6. Center for Health Equity and Evaluation Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1440, Houston, TX, 77030, USA

    R. A. Hajek

  7. The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    C. E. Blinka

  8. College of Nursing, Prairie View A&M University, 6436 Fannin Street, Houston, TX, 77030, USA

    L. A. Jones

  9. Graduate College of Social Work, University of Houston, 110HA Social Work Building #409, Houston, TX, 77204-4013, USA

    I. Torres-Vigil

  10. Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, FCT 5.6123 Unit 1414, Houston, TX, 77021, USA

    I. Torres-Vigil

Authors
  1. K. R. Enard
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  2. L. Nevarez
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  3. M. Hernandez
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  5. M. R. Moguel
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  6. R. A. Hajek
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  7. C. E. Blinka
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  8. L. A. Jones
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  9. I. Torres-Vigil
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Corresponding author

Correspondence to K. R. Enard.

Additional information

Clinical Trial Registration: NCT00453661.

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Enard, K.R., Nevarez, L., Hernandez, M. et al. Patient navigation to increase colorectal cancer screening among Latino Medicare enrollees: a randomized controlled trial. Cancer Causes Control 26, 1351–1359 (2015). https://doi.org/10.1007/s10552-015-0620-6

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  • DOI: https://doi.org/10.1007/s10552-015-0620-6

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