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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.

Author information

1
Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania. ronald.myers@jefferson.edu.
2
Lehigh Valley Health Network, Allentown, Pennsylvania.
3
Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania.
4
Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
5
Fox Chase Cancer Center, Philadelphia, Pennsylvania.
6
Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania.

Abstract

BACKGROUND:

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

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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

IMPACT:

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

TRIAL REGISTRATION:

ClinicalTrials.gov NCT02272244.

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