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Cancer Epidemiol Biomarkers Prev. 2019 Feb;28(2):384-391. doi: 10.1158/1055-9965.EPI-18-0260. Epub 2018 Oct 17.

Decision Support and Navigation to Increase Colorectal Cancer Screening Among Hispanic Patients.

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Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania.
Lehigh Valley Health Network, Allentown, Pennsylvania.
Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
Fox Chase Cancer Center, Philadelphia, Pennsylvania.
Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania.



Effective strategies are needed to raise colorectal cancer screening rates among Hispanics.


We surveyed and randomized 400 Hispanic primary care patients either to a Decision Support and Navigation Intervention (DSNI) Group (n = 197) or a Standard Intervention (SI) Group (n = 203). Both groups received a colorectal cancer screening kit [bilingual informational booklet, fecal immunochemical stool blood test (SBT), and colonoscopy screening instructions]. The DSNI Group received a telephone contact from a patient navigator. The navigator clarified screening test preference and likelihood of test performance, helped to develop a screening plan, and provided guidance through test performance. An endpoint telephone survey and medical chart review were completed. Multivariable analyses were conducted to assess 12-month screening adherence, change in decision stage, and knowledge and perceptions.


Screening adherence was significantly higher in the DSNI Group than the SI Group [OR, 4.8; 95% confidence interval (CI), 3.1-7.6]. The DSNI Group, compared with the SI Group, also displayed higher SBT screening [OR, 4.2; 95% CI, 2.6-6.7), higher colonoscopy screening (OR, 8.8; 95% CI, 4.1-18.7), and greater forward change in screening decision stage (OR, 4.9; 95% CI, 2.6-9.5). At endpoint, study groups did not differ in screening knowledge or perceptions.


The DSNI had a greater positive impact on colorectal cancer screening outcomes than the SI.


Health system implementation of DSNI strategies may help to reduce Hispanic colorectal cancer screening disparities in primary care.


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