Decision aid and patient navigator associated with improved colorectal cancer screening in vulnerable populations

1. In this randomized control trial, an intervention directed towards improving education and reducing barriers to colorectal cancer screening in vulnerable populations was associated with improved screening rates at 6 months.

2. Women were more likely to have improved screening rates than men exposed to the same intervention.

Evidence Rating Level: 2 (Good)       

Study Rundown: Colorectal cancer (CRC) remains one of the most common malignancies in the United States, but screening programs have led to increased detection, and reduced mortality. Vulnerable populations, including racial minorities, are less likely to participate in screening programs and are therefore at higher risk of CRC-associated morbidity. This study evaluated an intervention aimed at educating participants on CRC screening options and connecting them with a patient navigator to help reduce barriers to the desired testing strategy. The study found that compared to the control arm, those exposed to the intervention were significantly more likely to complete a screening strategy by 6 months follow up. Women had a larger increase in screening rates compared with men.

The strengths of the study included its randomized and controlled design with the final outcome assessed in a blinded manner. The main limitations included the small numbers in the study representing two small community health practices, reducing the generalizability. Additionally, the it is not clear whether the increased rates of FOBT/FIT led to increased rates of endoscopic evaluation in this population.

Click to read the study, published in JAMA Internal Medicine

Relevant Reading: Trends in Colorectal Cancer Test Use among Vulnerable Populations in the U.S.

In-Depth [randomized controlled trial]: This study included participants from two community health clinics (one in Albuquerque, New Mexico and one in Charlotte, North Carolina). The participants were between the ages of 50 to 75 years, spoke English or Spanish, had not had prior CRC screening, and had appointments at the clinics. Patients at high risk for CRC were excluded. The patients were randomized in a 1:1 ratio, and final outcome measures were obtained in a blinded fashion by chart review. The decision aid included either a Spanish or English language video that was presented prior to a participant’s clinic appointment and included education on FOBT/FIT, and endoscopic screening options, and how to connect with these resources. The patient navigator assisted participants interested in screening by providing testing kits, replacement kits for those that were lost, and following up with participants to assess completion.

Overall, 265 participants were included, with a mean age of 58 years, 62% Latino, 23% black or mixed race, and 15% as white. The majority of patients (78%) had median household income less than $20 000, 38% had low literacy, and 62% were uninsured or on Medicaid. Completion of CRC screening at 6 months occurred in 68% of the intervention group, and 27% in the control group for a 40 percentage point increase (95%CI 29-51 percentage points). Women constituted 65% of the study population and had a 50 percentage point increase in screening compared to men with 21 percentage points (p = 0.02).

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