A multilevel intervention to promote colorectal cancer screening among community health center patients: results of a pilot study

Karen E Lasser, Jennifer Murillo, Elizabeth Medlin, Sandra Lisboa, Lisa Valley-Shah, Robert H Fletcher, Karen M Emmons, John Z Ayanian, Karen E Lasser, Jennifer Murillo, Elizabeth Medlin, Sandra Lisboa, Lisa Valley-Shah, Robert H Fletcher, Karen M Emmons, John Z Ayanian

Abstract

Background: Colorectal cancer screening rates are low among poor and disadvantaged patients. Patient navigation has been shown to increase breast and cervical cancer screening rates, but few studies have looked at the potential of patient navigation to increase colorectal cancer screening rates.

Methods: The objective was to determine the feasibility and effectiveness of a patient navigator-based intervention to increase colorectal cancer screening rates in community health centers. Patients at the intervention health center who had not been screened for colorectal cancer and were designated as "appropriate for outreach" by their primary care providers received a letter from their provider about the need to be screened and a brochure about colorectal cancer screening. Patient navigators then called patients to discuss screening and to assist patients in obtaining screening. Patients at a demographically similar control health center received usual care.

Results: Thirty-one percent of intervention patients were screened at six months, versus nine percent of control patients (p < .001).

Conclusion: A patient navigator-based intervention, in combination with a letter from the patient's primary care provider, was associated with an increased rate of colorectal cancer screening at one health center as compared to a demographically similar control health center. Our study adds to an emerging literature supporting the use of patient navigators to increase colorectal cancer screening in diverse populations served by urban health centers.

Figures

Figure 1
Figure 1
Flow diagram of intervention patients.

References

    1. Agency for Healthcare Research and Quality
    1. Mandel JS, Bond JH, Church TR, Snover DC, Bradley GM, Schuman LM, Ederer F. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med. 1993;328:1365–1371. doi: 10.1056/NEJM199305133281901.
    1. Newcomb PA, Norfleet RG, Storer BE, Surawicz TS, Marcus PM. Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst. 1992;84:1572–1575. doi: 10.1093/jnci/84.20.1572.
    1. Selby JV, Friedman GD, Quesenberry CP, Jr, Weiss NS. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med. 1992;326:653–657.
    1. Winawer SJ, St John J, Bond J, Hardcastle JD, Kronborg O, Flehinger B, Schottenfeld D, Blinov NN. Screening of average-risk individuals for colorectal cancer. WHO Collaborating Centre for the Prevention of Colorectal Cancer. Bull World Health Organ. 1990;68:505–513.
    1. Grazzini G, Castiglione G, Ciabattoni C, Franceschini F, Giorgi D, Gozzi S, Mantellini P, Lopane P, Perco M, Rubeca T, et al. Colorectal cancer screening programme by faecal occult blood test in Tuscany: first round results. Eur J Cancer Prev. 2004;13:19–26. doi: 10.1097/00008469-200402000-00004.
    1. Cokkinides VE, Chao A, Smith RA, Vernon SW, Thun MJ. Correlates of Underutilization of Colorectal Cancer Screening among U.S. Adults, Age 50 Years and Older. Preventive Medicine. 2002;36:85–91. doi: 10.1006/pmed.2002.1127.
    1. Centers for Disease Control and Prevention Trends in screening for colorectal cancer-United States, 1997 and 1999. Morbidity and Mortality Weekly Report. 2001;50:162–166.
    1. Seeff LC, Nadel MR, Klabunde CN, Thompson T, Shapiro JA, Vernon SW, Coates RJ. Patterns and predictors of colorectal cancer test use in the adult U.S. population. Cancer. 2004;100:2093–2103. doi: 10.1002/cncr.20276.
    1. Walsh JM, Kaplan CP, Nguyen B, Gildengorin G, McPhee SJ, Perez-Stable EJ. Barriers to colorectal cancer screening in Latino and Vietnamese Americans. Compared with non-Latino white Americans. J Gen Intern Med. 2004;19:156–166. doi: 10.1111/j.1525-1497.2004.30263.x.
    1. Swan J, Breen N, Coates RJ, Rimer BK, Lee NC. Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey. Cancer. 2003;97:1528–1540. doi: 10.1002/cncr.11208.
    1. Walsh JME, Posner SF, Perez-Stable EJ. Colon Cancer Screening in the Ambulatory Setting. Preventive Medicine. 2002;35:209–218. doi: 10.1006/pmed.2002.1059.
    1. Goel MS, Wee CC, McCarthy EP, Davis RB, Ngo-Metzger Q, Phillips RS. Racial and ethnic disparities in cancer screening: the importance of foreign birth as a barrier to care. J Gen Intern Med. 2003;18:1028–1035. doi: 10.1111/j.1525-1497.2003.20807.x.
    1. Weller D, Coleman D, Robertson R, Butler P, Melia J, Campbell C, Parker R, Patnick J, Moss S. The UK colorectal cancer screening pilot: results of the second round of screening in England. Br J Cancer. 2007;97:1601–1605. doi: 10.1038/sj.bjc.6604089.
    1. Wee CC, McCarthy EP, Phillips RS. Factors associated with colon cancer screening: the role of patient factors and physician counseling. Prev Med. 2005;41:23–29. doi: 10.1016/j.ypmed.2004.11.004.
    1. Lasser KE, Ayanian JZ, Fletcher RH, Good MJ. Barriers to colorectal cancer screening in community health centers: a qualitative study. BMC Fam Pract. 2008;9:15. doi: 10.1186/1471-2296-9-15.
    1. Chen LA, Santos S, Jandorf L, Christie J, Castillo A, Winkel G, Itzkowitz S. A program to enhance completion of screening colonoscopy among urban minorities. Clin Gastroenterol Hepatol. 2008;6:443–450. doi: 10.1016/j.cgh.2007.12.009.
    1. Freeman HP. Patient navigation: a community based strategy to reduce cancer disparities. J Urban Health. 2006;83:139–141. doi: 10.1007/s11524-006-9030-0.
    1. Battaglia TA, Roloff K, Posner MA, Freund KM. Improving follow-up to abnormal breast cancer screening in an urban population. A patient navigation intervention. Cancer. 2007;109:359–367. doi: 10.1002/cncr.22354.
    1. Dohan D, Schrag D. Using navigators to improve care of underserved patients: current practices and approaches. Cancer. 2005;104:848–855. doi: 10.1002/cncr.21214.
    1. Jandorf L, Gutierrez Y, Lopez J, Christie J, Itzkowitz SH. Use of a patient navigator to increase colorectal cancer screening in an urban neighborhood health clinic. J Urban Health. 2005;82:216–224.
    1. Nash D, Azeez S, Vlahov D, Schori M. Evaluation of an intervention to increase screening colonoscopy in an urban public hospital setting. J Urban Health. 2006;83:231–243. doi: 10.1007/s11524-006-9029-6.
    1. Christie J, Itzkowitz S, Lihau-Nkanza I, Castillo A, Redd W, Jandorf L. A randomized controlled trial using patient navigation to increase colonoscopy screening among low-income minorities. J Natl Med Assoc. 2008;100:278–284.
    1. AHRQ Support for Primary Care Practice-Based Research Networks (PBRNs)
    1. National Quality Measures Clearinghouse
    1. Gross CP, McAvay GJ, Krumholz HM, Paltiel AD, Bhasin D, Tinetti ME. The effect of age and chronic illness on life expectancy after a diagnosis of colorectal cancer: implications for screening. Ann Intern Med. 2006;145:646–653.
    1. Prochaska J, C D. Toward a comprehensive model of change. In: Miller W, Healther N, editor. Treating Addictive Behaviours: Process of Change. New York: Plenum Pr; 1986. pp. 3–27.
    1. Dietrich AJ, Tobin JN, Cassells A, Robinson CM, Greene MA, Sox CH, Beach ML, DuHamel KN, Younge RG. Telephone care management to improve cancer screening among low-income women: a randomized, controlled trial. Ann Intern Med. 2006;144:563–571.
    1. More People Undergoing Colonoscopy in New York. New York Times; 2008. p. B6.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe