Use of a Patient Navigator to Increase Colorectal Cancer Screening in an Urban Neighborhood Health Clinic

Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY 10029, USA.
Journal of Urban Health (Impact Factor: 1.9). 07/2005; 82(2):216-24. DOI: 10.1093/jurban/jti046
Source: PubMed


Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Racial disparities in CRC incidence and mortality have been well documented. In addition, lower rates of CRC screening among ethnic minorities have been reported. Therefore, we tested the effectiveness of a patient navigator (PN) in increasing compliance with CRC screening in a minority community health setting. Men and women aged 50 or older attending a primary care practice were enrolled if they had not had a fecal occult blood test within the past year, a sigmoidoscopy or barium enema within the past 3-5 years, or a colonoscopy within the past 10 years. Participants were randomly assigned either to receive navigator services (PN+) or not to receive navigator services (PN-). There were no demographic differences between the two groups. Within 6 months of physician recommendation, 15.8% in the PN+group had complied with an endoscopic examination, compared with only 5% in the PN - group (P=.019). The PN+group also demonstrated higher rates of fecal occult blood test completion (42.1% vs. 25%, P=.086). Thus, a PN system successfully increases CRC screening rates among a predominantly minority population of low socioeconomic status.

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Available from: Lina Jandorf, Feb 18, 2014
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    • "We incorporated strategies such as modeling, vicarious reinforcement , information delivery, distribution of FIT test kits, and guided practice for FIT completion. Evidencebased strategies include reducing structural barriers through provision of the FIT kits (Feldstein et al., 2012; Myers et al., 2007; Sequist, Zaslavsky, Marshall, Fletcher, & Ayanian, 2009; Tu et al., 2006; Walsh et al., 2010), use of patient navigators to reduce system and behavioral barriers to screening and diagnostic followup (Freund et al., 2014; Jandorf et al., 2005; Percac- Lima et al., 2009; Raich et al., 2012; Wells et al., 2012), one-on-one education (Dietrich et al., 2006; Tu et al., 2006; Walsh et al., 2010), use of small media such as video, and flip charts (Myers et al., 2007; Tu et al., 2006), use of reminder calls and letters (Greiner et al., 2005; Myers et al., 1991), and cultural tailoring (Percac- Lima et al., 2009; Tu et al., 2006; Walsh et al., 2010). "
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    ABSTRACT: Colorectal cancer is the second leading cause of cancer-related death in the United States. Despite universal screening recommendations, screening rates in the United States remain suboptimal, especially among the poor, the uninsured, recent immigrants, and Hispanics. This article describes the development of a large community-based colorectal cancer screening program designed to address these disparities. The Against Colorectal Cancer in our Neighborhoods program is a bilingual, evidence-based, theory-guided, multicomponent community screening intervention, targeting the uninsured and developed using a systematic planning process. It combines community health worker-led outreach, bilingual and culturally tailored community education, and no-cost screening with provision of the fecal immunochemical test or colonoscopy and navigation services. A detailed process and outcome evaluation is planned. Program development cost calculated prospectively (in 2011 dollars) using a societal perspective and micro-costing methods was $243,278, of which $180,344 was direct cost. The detailed description of the development processes and costs of this health promotion program targeting low-income Hispanics will inform health program decision makers about the resource requirements for planning and developing new programs to reduce disease burden in communities. © 2015 Society for Public Health Education.
    Health Promotion Practice 05/2015; 16(5). DOI:10.1177/1524839915587265 · 0.55 Impact Factor
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    • "Training outcomes— n/a. Intervention outcomes—n/a J Canc Educ (2015) 30:173–186 179 Author's personal copy Table 2 Clinic-based navigator programs (n=12) Author (year), title, journal Purpose of the study Setting Target group Identification/ Recruitment Study Design Theory/ Construct CHN training CHN intervention Results/Outcome Jandorf et al. (2005) "
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    ABSTRACT: This study synthesized lessons learned from US-based community and clinic health navigator (CHN) interventions on cancer screening promotion to identify characteristics of models and approaches for addressing cancer disparities. The combination terms "cancer screening" and "community health workers or navigators" or "patient navigators" were used in searching Medline, CINAHL, and PsycInfo. A total of 27 articles published during January 2005∼April 2014 were included. Two CHN models were identified: community-based (15 studies) and clinic/hospital-based (12 studies). While both models used the term "navigators," most community-based programs referred them as community health workers/navigators/advisors, whereas clinic-based programs often called them patient navigators. Most community-based CHN interventions targeted specific racial/ethnic minority or rural groups, while clinic-based programs mostly targeted urban low income or mixed ethnic groups. Most community-based CHN programs outreached members from community networks, while clinic-based programs commonly worked with pre-identified in-service clients. Overall, regardless model type, CHNs had similar roles and responsibilities, and interventions demonstrated effective outcomes. Our review identified characteristics of CHN interventions with attention to different settings. Lessons learned have implication on the dissemination and implementation of CHN interventions for cancer screening promotion across setting and target groups.
    Journal of Cancer Education 09/2014; 30(1). DOI:10.1007/s13187-014-0723-x · 1.23 Impact Factor
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    • "In 9 of the studies, the intervention was compared with usual care [42] [45] [46] [50] [52] [55] [56] [58]. In 6 of them (67%), the intervention increased participation rates compared with usual care [42] [46] [50] [52] [55] [56]. Overall, in 12 of the RCT (80%), the intervention increased participation rates [26, 42, 46, 50–57, 115]. "
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    ABSTRACT: Colorectal cancer ranks as one of the most incidental and death malignancies worldwide. Colorectal cancer screening has proven its benefit in terms of incidence and mortality reduction in randomized controlled trials. In fact, it has been recommended by medical organizations either in average-risk or family-risk populations. Success of a screening campaign highly depends on how compliant the target population is. Several factors influence colorectal cancer screening uptake including sociodemographics, provider and healthcare system factors, and psychosocial factors. Awareness of the target population of colorectal cancer and screening is crucial in order to increase screening participation rates. Knowledge about this disease and its prevention has been used across studies as a measurement of public awareness. Some studies found a positive relationship between knowledge about colorectal cancer, risk perception, and attitudes (perceived benefits and barriers against screening) and willingness to participate in a colorectal cancer screening campaign. The mentioned factors are modifiable and therefore susceptible of intervention. In fact, interventional studies focused on average-risk population have tried to increase colorectal cancer screening uptake by improving public knowledge and modifying attitudes. In the present paper, we reviewed the factors impacting adherence to colorectal cancer screening and interventions targeting participants for increasing screening uptake.
    03/2014; 2014:425787. DOI:10.1155/2014/425787
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