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Baggett TP, Sporn N, Barbosa Teixeira J, Rodriguez EC, Anandakugan N, Critchley N, Kennedy E, Hart K, Joyce A, Chang Y, Percac-Lima S, Park ER, Rigotti NA. Patient Navigation for Lung Cancer Screening at a Health Care for the Homeless Program: A Randomized Clinical Trial. JAMA Intern Med 2024; 184:892-902. [PMID: 38856994 PMCID: PMC11165412 DOI: 10.1001/jamainternmed.2024.1662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/21/2024] [Indexed: 06/11/2024]
Abstract
Importance People experiencing homelessness die of lung cancer at rates more than double those in the general population. Lung cancer screening (LCS) with low-dose computed tomography (LDCT) reduces lung cancer mortality, but the circumstances of homelessness create barriers to LCS participation. Objective To determine whether patient navigation, added to usual care, improved LCS LDCT receipt at a large Health Care for the Homeless (HCH) program. Design, Setting, and Participants This parallel group, pragmatic, mixed-methods randomized clinical trial was conducted at Boston Health Care for the Homeless Program (BHCHP), a federally qualified HCH program that provides tailored, multidisciplinary care to nearly 10 000 homeless-experienced patients annually. Eligible individuals had a lifetime history of homelessness, had a BHCHP primary care practitioner (PCP), were proficient in English, and met the pre-2022 Medicare coverage criteria for LCS (aged 55-77 years, ≥30 pack-year history of smoking, and smoking within the past 15 years). The study was conducted between November 20, 2020, and March 29, 2023. Intervention Participants were randomized 2:1 to usual BHCHP care either with or without patient navigation. Following a theory-based, patient-centered protocol, the navigator provided lung cancer education, facilitated LCS shared decision-making visits with PCPs, assisted participants in making and attending LCS LDCT appointments, arranged follow-up when needed, and offered tobacco cessation support for current smokers. Main Outcomes and Measures The primary outcome was receipt of a 1-time LCS LDCT within 6 months after randomization, with between-group differences assessed by χ2 analysis. Qualitative interviews assessed the perceptions of participants and PCPs about the navigation intervention. Results In all, 260 participants (mean [SD] age, 60.5 [4.7] years; 184 males [70.8%]; 96 non-Hispanic Black participants [36.9%] and 96 non-Hispanic White participants [36.9%]) were randomly assigned to usual care with (n = 173) or without (n = 87) patient navigation. At 6 months after randomization, 75 participants in the patient navigation arm (43.4%) and 8 of those in the usual care-only arm (9.2%) had completed LCS LDCT (P < .001), representing a 4.7-fold difference. Interviews with participants in the patient navigation arm and PCPs identified key elements of the intervention: multidimensional social support provision, care coordination activities, and interpersonal skills of the navigator. Conclusions and Relevance In this randomized clinical trial, patient navigation support produced a 4.7-fold increase in 1-time LCS LDCT completion among HCH patients in Boston. Future work should focus on longer-term screening participation and outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT04308226.
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Affiliation(s)
- Travis P. Baggett
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Mongan Institute, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Institute for Research, Quality & Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
| | - Nora Sporn
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
| | - Joana Barbosa Teixeira
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
| | | | | | - Natalia Critchley
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
| | - Evangeline Kennedy
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
| | - Katherine Hart
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
| | - Andrea Joyce
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
| | - Yuchiao Chang
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Mongan Institute, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Sanja Percac-Lima
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Mongan Institute, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Elyse R. Park
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Mongan Institute, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Nancy A. Rigotti
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Mongan Institute, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
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Schubel L, Mete M, Fong A, Boxley C, Barac A, Gallagher C, Magee MF, Arem H. Understanding Perceptions of Care Coordination and Chronic Illness Management among Black Breast and Prostate Cancer Survivors and Providers: Findings from a Quality Improvement Study. J Ambul Care Manage 2024:00004479-990000000-00049. [PMID: 39028275 DOI: 10.1097/jac.0000000000000505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Navigating cancer care is complex and is exacerbated by pre-existing comorbidities managed by multiple providers. In this quality improvement study, we evaluated changes in perceived care coordination, navigation, and chronic illness care with community health worker (CHW) and mHealth support among Black breast cancer and prostate cancer patients with hypertension and/or diabetes. We collected patient and provider surveys on chronic illness care coordination at baseline and six months and found improvements in multiple domains. These findings support engaging CHWs to improve care coordination among cancer patients with comorbidities and demonstrate a use case of importance with emerging navigation reimbursement policies.
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Affiliation(s)
- Laura Schubel
- Author Affiliations: National Center for Human Factors in Healthcare, Healthcare Delivery Research (Ms Schubel), Implementation Science, Healthcare Delivery Research (Ms Schubel and Dr Arem), Center for Biostatistics, Informatics, and Data Science, Healthcare Delivery Research (Dr Mete and Messrs Fong and Boxley), MedStar Health Research Institute, Washington, District of Columbia; Heart and Vascular Institute (Dr Barac), MedStar Washington Hospital Center (Dr Gallagher), Diabetes and Research Institutes (Dr Magee), MedStar Health, Washington, District of Columbia; Department of Psychiatry, School of Medicine (Dr Mete), Department of Medicine, School of Medicine (Drs Barac and Magee), Department of Oncology (Dr Arem), Georgetown University, Washington, District of Columbia; and Heart and Vascular Institute, Inova Health System (Dr Barac), Falls Church, Virginia
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Priego-Parra BA, Triana-Romero A, Inurreta-Vásquez A, Laffitte-García H, Violante-Hernández GA, Jiménez-Rodríguez SS, Martínez-Pérez GP, Meixueiro-Daza A, Grube-Pagola P, Remes-Troche JM. Colorectal cancer screening program implementation: biennial adherence and participation patterns. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2024; 89:354-361. [PMID: 38862361 DOI: 10.1016/j.rgmxen.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/26/2023] [Indexed: 06/13/2024]
Abstract
INTRODUCTION AND AIM Adherence to colorectal cancer (CRC) screening is essential for the effectiveness of screening programs. Even though organized screening programs can improve the quality of the process and adherence, there are still challenges to overcome. The aim of the present study, in which we implemented a biennial organized screening program for CRC, was to describe adherence and participation patterns. MATERIALS AND METHODS A longitudinal, descriptive study was conducted, in which a team of trained patient navigators carried out interventions, with reminders via cellphone communication, to follow a cohort of 301 subjects eligible for CRC screening, utilizing a fecal immunochemical test (FIT). All the follow-up subjects received a FIT kit. RESULTS A total of 747 cellphone calls were made and divided into three interventions. From the initial cohort, 126 subjects completed their biennial screening process through the FIT, indicating a consistent adherence rate of 41.8% to our program. The participation patterns were: 126 consistent participants (41.8%), 160 inconsistent participants (53.2%), and 15 participants that were never contacted (5%). CONCLUSIONS In conclusion, our study underlines the importance of organized screening programs in the early detection of CRC. The implementation of follow-up interventions, through reminders and the training of patient navigators, can improve adherence, but there is a need for examining new strategies, to overcome barriers to communication via cellphone.
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Affiliation(s)
- B A Priego-Parra
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico.
| | - A Triana-Romero
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - A Inurreta-Vásquez
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - H Laffitte-García
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - G A Violante-Hernández
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - S S Jiménez-Rodríguez
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - G P Martínez-Pérez
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - A Meixueiro-Daza
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - P Grube-Pagola
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - J M Remes-Troche
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
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Thompson JH, Rivelli JS, Schneider JL, Kenzie ES, Myers E, Coury J, Davis M, Gautom P, Coronado GD. Adaptations to a patient navigation program for follow-up colonoscopy in rural primary care practices. J Eval Clin Pract 2024. [PMID: 38935862 DOI: 10.1111/jep.14068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/09/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE Patient navigation is a recommended practice to improve cancer screenings among underserved populations including those residing in rural areas with care access barriers. We report on patient navigation programme adaptations to increase follow-up colonoscopy rates after abnormal fecal testing in rural primary care practices. METHODS Participating clinics delivered a patient navigation programme to eligible patients from 28 affiliated clinics serving rural communities in Oregon clustered within 3 Medicaid health plans. Patient navigation adaptations were tracked using data sources including patient navigation training programme reflections, qualitative interviews, clinic meetings, and periodic reflections with practice facilitators. FINDINGS Initial, planned (proactive) adaptations were made to address the rural context; later, unplanned (reactive) adaptations were implemented to address the impact of the COVID-19 global pandemic. Initial planned adaptations to the patient navigation programme were made before the main trial to address the needs of the rural context, including provider shortages and geographic dispersion limiting both patient access to care and training opportunities for providers. Later unplanned adaptations were made primarily in response to COVID-19 care suspension and staff redeployments and shortages that occurred during implementation. CONCLUSION While unplanned adaptations were implemented to address the contextual impact of the COVID-19 pandemic on care access patterns and staffing, the changes to training content and context were beneficial to the rural setting overall and should be sustained. Our findings can guide future efforts to optimise the success of such programmes in other rural settings and highlight the important role of adaptations in implementation projects.
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Affiliation(s)
- Jamie H Thompson
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Jennifer S Rivelli
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Jennifer L Schneider
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Erin S Kenzie
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, USA
- OHSU-PSU School of Public Health Division, Oregon Health & Science University, Portland, Oregon, USA
| | - Emily Myers
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, USA
| | - Jennifer Coury
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, USA
| | - Melinda Davis
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, USA
- OHSU-PSU School of Public Health Division, Oregon Health & Science University, Portland, Oregon, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Priyanka Gautom
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
- OHSU-PSU School of Public Health Division, Oregon Health & Science University, Portland, Oregon, USA
| | - Gloria D Coronado
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
- Department of Population Sciences, University of Arizona Cancer Center, Tucson, Arizona, USA
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
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Patel A, Lebron VM, Pabalan A, Schueler SA, El-Bayoumi J, Onumah C, Borum ML. Engaging the community on colorectal cancer screening: Additional factors identified by African Americans as potential barriers during focus groups. J Natl Med Assoc 2023; 115:580-583. [PMID: 37852880 DOI: 10.1016/j.jnma.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE African-Americans have the highest rate of colorectal cancer deaths. Adherence to colorectal cancer screening guidelines can improve outcomes. The objective of this study was to evaluate physician trust and barriers to screening utilizing a unique bi-directional learning focus group involving African-American adults and health care learners. METHODS A focus group of African-American adults from a community church and university health care learners was conducted to identify colon cancer screening barriers. Health care learners were medical students, resident physicians and gastroenterology fellows. Pre-focus group surveys, including the Wake Forest Physician Trust Scale (WFPTS) and a colon cancer screening knowledge survey, were administered. Audio recording of the focus group was transcribed with subsequent thematic analysis. A post-focus group survey evaluated the colorectal cancer screening barriers identified during the focus group. Analysis of pre- and post- focus group surveys was performed using Fisher Exact test with significance set at p<0.05. RESULTS The focus group consisted of 18 members (7 African-American community members, 11 non-African American health care learners). WFPTS revealed that 83% (86% community members, 82% health care learners; p = 1.0) strongly agree / agree that their physician would advocate for their health. 77% (86% community members, 73% health care learners; p = 1.0) strongly agree / agree that they trusted their physician. 100% recognized that colon cancer screening is recommended. The focus group identified lack of awareness (81%), colonoscopy preparation (81%), trust in physician (60%), lack of insurance coverage (56%), transportation (56%), colonoscopy wait time (50%), insufficient physician discussion (50%) and fear of procedure or cancer (35%) as screening barriers. Post-focus group surveys revealed that community members more frequently identified racial disparity in health care (p = 0.0474), physician respect toward patients (p = 0.0128) and insufficient physician discussion (p = 0.0006) as screening barriers. CONCLUSIONS Focus group discussion identified multiple barriers for colorectal cancer screening. Notably, differences in the perceptions of African-American community members and non-African-American health care learners about racial disparity in health care, physician respect toward patients and insufficient physician discussion were revealed. The integration of bi-directional focus group learning can be considered as a potential strategy to assist in the development of focused screening interventions.
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Affiliation(s)
- Ankit Patel
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Valeria Martinez Lebron
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Ana Pabalan
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Samuel A Schueler
- Division of Gastroenterology and Liver Diseases, Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington DC, USA
| | - Jehan El-Bayoumi
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Chavon Onumah
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Marie L Borum
- Division of Gastroenterology and Liver Diseases, Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington DC, USA.
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Richardson-Parry A, Silva M, Valderas JM, Donde S, Woodruff S, van Vugt J. Video Interventions for Reducing Health Inequity in Cancer Screening Programmes: a Systematic Review. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01749-5. [PMID: 37603223 DOI: 10.1007/s40615-023-01749-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Health equity can lead to disparities in cancer screening, treatment, and mortality. This systematic review aims to identify and describe interventions that used video or DVD formats to reduce health inequity in cancer screening and review the effectiveness of such interventions in increasing screening rates compared to usual care conditions. METHODS We searched PubMed, Web of Science, Embase, and Cochrane databases for randomized control trials (RCTs) published until 18/01/2023 that compared intervention versus usual care control groups, with the percentage of cancer screening uptake during follow-up as an outcome. The risk of Bias was assessed with the Cochrane Collaboration tool. RESULTS After screening 4201 abstracts, 192 full texts were assessed for eligibility and 18 were included that focused on colorectal (n = 9), cervical (n = 5), breast (n = 5), and prostate (n = 1) cancer screening. All were based in the USA except one and most focused on ethnicity/race, while some included low-income populations. Most of the video interventions used to increase cervical cancer screening reported positive results. Studies aimed at increasing mammography uptake were mostly effective only in specific groups of participants, such as low-income or less-educated African American women. Results for colorectal cancer screening were conflicting. Videos that were culturally tailored or used emotive format were generally more effective than information-only videos. CONCLUSIONS Video interventions to increase cancer screening among populations with low screening uptake show some positive effects, though results are mixed. Interventions that use individual and cultural tailoring of the educational material should be further developed and investigated outside of the USA.
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Affiliation(s)
| | - Mitchell Silva
- Esperity, Veldkapelgaarde 30b1.30.30, 1200, Brussels, Belgium
| | - Jose Maria Valderas
- Department of Family Medicine, National University Health System and Yong Loo Lin School of Medicine, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore
| | - Shaantanu Donde
- Viatris, Building 4, Trident Place, Mosquito Way, Hatfield, AL10 9UL, UK
| | | | - Joris van Vugt
- Viatris, Krijgsman 20, Amstelveen, 1186DM, The Netherlands
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Richardson-Parry A, Silva M, Valderas JM, Donde S, Woodruff S, van Vugt J. Interactive or tailored digital interventions to increase uptake in cervical, breast, and colorectal cancer screening to reduce health inequity: a systematic review. Eur J Cancer Prev 2023; 32:396-409. [PMID: 37144585 PMCID: PMC10249608 DOI: 10.1097/cej.0000000000000796] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Significant health inequities exist in screening uptake for certain types of cancer. The review question was to identify and describe interactive, tailored digital, computer, and web-based interventions to reduce health inequity in cancer screening and review the effectiveness of such interventions in increasing screening rates versus usual care. METHODS We searched four medical literature databases for randomized control trials (RCTs) published until 12 January 2023 that evaluated interventions aimed at increasing the percentage of breast, prostate, cervical, or colorectal cancer screening uptake. Meta-analysis was not conducted due to heterogeneity among studies. RESULTS After screening 4200 titles and abstracts, 17 studies were included. Studies focused on colorectal ( n = 10), breast ( n = 4), cervical ( n = 2), and prostate ( n = 1) cancer screening. All were based in the USA except two. Most studies focused on ethnicity/race, while some included low-income populations. Intervention types were heterogeneous and used computer programs, apps, or web-based methods to provide tailored or interactive information to participants about screening risks and options. Some studies found positive effects for increasing cancer screening uptake in the intervention groups compared to usual care, but results were heterogeneous. CONCLUSION Interventions that use individual and cultural tailoring of cancer screening educational material should be further developed and investigated outside of the USA. Designing effective digital intervention strategies, with components that can be adapted to remote delivery may be an important strategy for reducing health inequities in cancer screening during the coronavirus disease 2019 pandemic.
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Affiliation(s)
| | | | - Jose M. Valderas
- Department of Family Medicine, National University Health System and Yong Loo Lin School of Medicine, Centre for Research in Health Systems Performance, Singapore, Singapore
| | - Shaantanu Donde
- European Developed Markets Medical Affairs Viatris, Hatfield, UK
| | - Seth Woodruff
- North America Medical Affairs, Viatris, New York, USA
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Mosquera I, Todd A, Balaj M, Zhang L, Benitez Majano S, Mensah K, Eikemo TA, Basu P, Carvalho AL. Components and effectiveness of patient navigation programmes to increase participation to breast, cervical and colorectal cancer screening: A systematic review. Cancer Med 2023; 12:14584-14611. [PMID: 37245225 PMCID: PMC10358261 DOI: 10.1002/cam4.6050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/03/2023] [Accepted: 04/26/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Inequalities in cancer incidence and mortality can be partly explained by unequal access to high-quality health services, including cancer screening. Several interventions have been described to increase access to cancer screening, among them patient navigation (PN), a barrier-focused intervention. This systematic review aimed to identify the reported components of PN and to assess the effectiveness of PN to promote breast, cervical and colorectal cancer screening. METHODS We searched Embase, PubMed and Web of Science Core Collection databases. The components of PN programmes were identified, including the types of barriers addressed by navigators. The percentage change in screening participation was calculated. RESULTS The 44 studies included were mainly on colorectal cancer and were conducted in the USA. All described their goals and community characteristics, and the majority reported the setting (97.7%), monitoring and evaluation (97.7%), navigator background and qualifications (81.4%) and training (79.1%). Supervision was only referred to in 16 studies (36.4%). Programmes addressed mainly barriers at the educational (63.6%) and health system level (61.4%), while only 25.0% reported providing social and emotional support. PN increased cancer screening participation when compared with usual care (0.4% to 250.6% higher) and educational interventions (3.3% to 3558.0% higher). CONCLUSION Patient navigation programmes are effective at increasing participation to breast, cervical and colorectal cancer screening. A standardized reporting of the components of PN programmes would allow their replication and a better measure of their impact. Understanding the local context and needs is essential to design a successful PN programme.
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Affiliation(s)
- Isabel Mosquera
- Early Detection, Prevention & Infections Branch, International Agency for Research on CancerLyonFrance
| | - Adam Todd
- School of PharmacyNewcastle University, Newcastle upon TyneUK
| | - Mirza Balaj
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Li Zhang
- Early Detection, Prevention & Infections Branch, International Agency for Research on CancerLyonFrance
| | - Sara Benitez Majano
- Noncommunicable Diseases, Violence and Injuries Prevention Unit, Pan American Health OrganizationWashingtonDCUSA
- Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical MedicineLondonUK
| | - Keitly Mensah
- Early Detection, Prevention & Infections Branch, International Agency for Research on CancerLyonFrance
| | - Terje Andreas Eikemo
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Partha Basu
- Early Detection, Prevention & Infections Branch, International Agency for Research on CancerLyonFrance
| | - Andre L. Carvalho
- Early Detection, Prevention & Infections Branch, International Agency for Research on CancerLyonFrance
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Abdul Latip SNB, Chen SE, Im YR, Zielinska AP, Pawa N. Systematic review of randomised controlled trials on interventions aimed at promoting colorectal cancer screening amongst ethnic minorities. ETHNICITY & HEALTH 2023; 28:661-695. [PMID: 36352539 DOI: 10.1080/13557858.2022.2139815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 10/16/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Significant disparities exist between different ethnic groups when it comes to participation in colorectal cancer (CRC) screening programmes. A variety of interventions have been proposed to improve participation rates of ethnic minorities for CRC screening. This systematic review aims to appraise the evidence available from published randomised controlled trials (RCTs) and to identify effective interventions aimed at promoting CRC screening amongst underserved ethnic minorities. DESIGN We searched EmBASE, Medline, PsychInfo, Scopus and CINAHL for RCTs that analysed interventions to promote CRC screening in all ethnic minorities. CRC screening was measured as documented or self-reported screening rates. The protocol of this study was registered prospectively on PROSPERO with the registration number CRD42020216384. RESULTS We identified 42 relevant RCT articles, out of 1805 articles highlighted by the initial search. All except one were conducted in the US. The most frequently studied ethnic groups were African-Americans (33%), East Asians (30%), and Hispanics/Latinos (23%). In total, 7/42 (16%) RCTs had multiple arms. Interventions mainly intended to educate (52%), provide patient navigation services (21%), or provide a combination of these interventions (19%). We demonstrate that combination methods are most effective. CONCLUSION Many RCTs, mostly in the US, have trialed interventions aimed to increase CRC screening uptake amongst ethnic minorities to varying success. We conclude that using a combination of methods with patient navigation, education, and cultural tailoring is most effective at increasing CRC screening uptake amongst ethnic minorities. This highlights that multiple factors may hinder CRC screening and finding a one-size-fits-all solution that can be reliably implemented among different cultures and countries may be complex.
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Affiliation(s)
- Siti Nadiah Binte Abdul Latip
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
| | | | - Yu Ri Im
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Agata P Zielinska
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Nikhil Pawa
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
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Coronado GD, Ferrari RM, Barnes A, Castañeda SF, Cromo M, Davis MM, Doescher MP, English K, Hatcher J, Kim KE, Kobrin S, Liebovitz D, Mishra SI, Nodora JN, Norton WE, Oliveri JM, Reuland DS, Subramanian S, Thompson JH, Paskett ED. Characteristics of patient navigation programs in the Cancer Moonshot ACCSIS colorectal cancer screening initiative. J Natl Cancer Inst 2023; 115:680-694. [PMID: 36810931 PMCID: PMC10248850 DOI: 10.1093/jnci/djad032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/01/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Although patient navigation has shown promise for increasing participation in colorectal cancer screening and follow-up, little evidence is available to guide implementation of patient navigation in clinical practice. We characterize 8 patient navigation programs being implemented as part of multi-component interventions of the National Cancer Institute's Cancer Moonshot Accelerating Colorectal Cancer Screening and Follow-Up Through Implementation Science (ACCSIS) initiative. METHODS We developed a data collection template organized by ACCSIS framework domains. The template was populated by a representative from each of the 8 ACCSIS research projects. We report standardized descriptions of 1) the socio-ecological context in which the navigation program was being conducted, 2) navigation program characteristics, 3) activities undertaken to facilitate program implementation (eg, training), and 4) outcomes used in program evaluation. RESULTS ACCSIS patient navigation programs varied broadly in their socio-ecological context and settings, the populations they served, and how they were implemented in practice. Six research projects adapted and implemented evidence-based patient navigation programs; the remaining projects developed new programs. Five projects began navigation when patients were due for initial colorectal cancer screening; 3 projects began navigation later in the screening process, when patients were due for follow-up colonoscopy after an abnormal stool-test result. Seven projects relied on existing clinical staff to deliver the navigation; 1 hired a centralized research navigator. All project researchers plan to evaluate the effectiveness and implementation of their programs. CONCLUSIONS Our detailed program descriptions may facilitate cross-project comparisons and guide future implementation and evaluation of patient navigation programs in clinical practice.
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Affiliation(s)
| | - Renée M Ferrari
- Lineberger Comprehensive Cancer Center, Carolina Cancer Screening Initiative, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Autumn Barnes
- Research Triangle International, Research Triangle Park, NC, USA
| | - Sheila F Castañeda
- Department of Psychology, South Bay Latino Research Center, San Diego State University, Chula Vista, CA, USA
| | - Mark Cromo
- Department of Internal Medicine, Healthy Kentucky Research Building, University of Kentucky, Lexington, KY, USA
| | - Melinda M Davis
- Department of Family Medicine and School of Public Health, Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland, OR, USA
| | - Mark P Doescher
- Department of Family and Preventive Medicine, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, University of Oklahoma, Oklahoma City, OK, USA
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque Area Indian Health Board, Inc, Albuquerque, NM, USA
| | - Jenna Hatcher
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | | | - Sarah Kobrin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - David Liebovitz
- Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shiraz I Mishra
- University of New Mexico Comprehensive Cancer Center and Departments of Pediatrics and Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Jesse N Nodora
- Department of Family Medicine and Public Health, Moores UC San Diego Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Wynne E Norton
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Jill M Oliveri
- Comprehensive Cancer Center, Ohio State University, Columbus, OH, USA
| | - Daniel S Reuland
- Lineberger Comprehensive Cancer Center, Carolina Cancer Screening Initiative, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Electra D Paskett
- Department of Internal Medicine, College of Medicine and Comprehensive Cancer Center, Ohio State University, Columbus, OH, USA
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Effectiveness of Community Health Worker-Led Interventions in Enhancing Colorectal Cancer Screening Uptake in Racial and Ethnic Minority Populations: A Systematic Review and Meta-analysis. Cancer Nurs 2023:00002820-990000000-00126. [PMID: 36927698 DOI: 10.1097/ncc.0000000000001222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND The colorectal cancer (CRC) screening uptake rate is substantially lower in ethnic minority populations than in the general population. Racial and ethnic minority individuals experience more barriers in obtaining a screening test for CRC when compared with the non-Hispanic White population. OBJECTIVE To examine the effectiveness of community health worker-led interventions in improving the CRC screening uptake rate in racial and ethnic minority populations. METHODS Five databases, EMBASE, CINAHL, MEDLINE, Scopus, and PubMed, were systematically searched, and reference lists of the identified articles were manually searched for relevant articles in May 2022. Only randomized controlled trials were included. RESULTS A total of 10 randomized controlled trials conducted in the United States were included in this review. The findings of the meta-analysis showed that CRC screening uptake was enhanced in participants receiving community health worker-led interventions compared with those receiving no intervention (odds ratio, 2.25; 95% confidence interval, 1.48-3.44; P < .001). The subgroup analysis by diverse racial and ethnic groups and number of components (single vs multiple) of the community health worker-led interventions showed that multicomponent interventions were more effective in increasing the CRC uptake rate among all racial and ethnic groups regardless of their background. CONCLUSIONS Multicomponent community health worker-led interventions can improve CRC screening uptake in racial and ethnic minority populations. IMPLICATIONS FOR PRACTICE The findings of the present review show that multicomponent community health worker-led interventions are shown to be effective to improve the CRC screening uptake targeting other racial and ethnic minority groups in other countries.
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Richardson-Parry A, Baas C, Donde S, Ferraiolo B, Karmo M, Maravic Z, Münter L, Ricci-Cabello I, Silva M, Tinianov S, Valderas JM, Woodruff S, van Vugt J. Interventions to reduce cancer screening inequities: the perspective and role of patients, advocacy groups, and empowerment organizations. Int J Equity Health 2023; 22:19. [PMID: 36707816 PMCID: PMC9880917 DOI: 10.1186/s12939-023-01841-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/21/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Health inequities lead to low rates of cancer screening in certain populations, such as low-income and ethnic minority groups. Different interventions to address this have been developed with mixed results. However, interventions are not always developed in collaboration with the people they target. The aim of our article is to present the viewpoint of patients, survivors, advocates, and lay persons on interventions to increase cancer screening from a health inequity perspective. METHODS We prepared talking points to guide discussions between coauthors, who included representatives from nine patient and survivor advocacy groups, organizations working for citizen/patient empowerment, and health equity experts. Perspectives and opinions were first collected through video conferencing meetings and a first draft of the paper was prepared. All authors, read through, revised, and discussed the contents to reach an agreement on the final perspectives to be presented. RESULTS Several themes were identified: it is important to not view screening as a discrete event; barriers underlying an individual's access and willingness to undergo screening span across a continuum; individually tailored interventions are likely to be more effective than a one-size fits-all approach because they may better accommodate the person's personal beliefs, knowledge, behaviors, and preferences; targeting people who are unknown to medical services and largely unreachable is a major challenge; including professional patient advocacy groups and relevant lay persons in the cocreation of interventions at all stages of design, implementation, and evaluation is essential along with relevant stakeholders (healthcare professionals, researchers, local government and community organizations etc). CONCLUSIONS Interventions to address cancer screening inequity currently do not adequately solve the issue, especially from the viewpoint of patients, survivors, and lay persons. Several core pathways should be focused on when designing and implementing interventions: advancing individually tailored interventions; digital tools and social media; peer-based approaches; empowerment; addressing policy and system barriers; better design of interventions; and collaboration, including the involvement of patients and patient advocacy organizations.
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Affiliation(s)
- Afua Richardson-Parry
- Viatris Global Healthcare UK, Building 4, Trident Place, Mosquito Way, Hatfield, London, AL10 9UL UK
| | - Carole Baas
- grid.470316.7Alamo Breast Cancer Foundation, 909 Midland Creek Drive, Southlake, TX 76092 USA
| | - Shaantanu Donde
- Viatris Global Healthcare, Building 4, Trident Place, Mosquito Way, Hatfield, London, AL10 9UL UK
| | - Bianca Ferraiolo
- Cittadinanzattiva - Active Citizenship Network, Rue Philippe Le Bon 46, 1000 Brussels, Belgium
| | - Maimah Karmo
- grid.430731.2Tigerlily Foundation, 42020 Village Center Plaza, #120-156, Stone Ridge, 20105 USA
| | - Zorana Maravic
- Digestive Cancers Europe, Rue de la Loi 235/27, 1040 Brussels, Belgium
| | - Lars Münter
- Danish Committee for Health Education, Classensgade 71, 5, 2100 Copenhagen, Denmark
| | - Ignacio Ricci-Cabello
- grid.507085.fBalearic Islands Health Research Institute (IdISBa) and CIBER de Epidemiología y Salud Pública (CIBERESP), C/ Escola Graduada 3, 07002 Palma, Balearic Islands Spain
| | - Mitchell Silva
- Esperity, Clos Chapelle-aux-Champs 30, 1200 Brussels, Belgium
| | - Stacey Tinianov
- Advocates for Collaborative Education, 824 Windsor Street, Santa Cruz, CA 95062 USA
| | - Jose M. Valderas
- grid.4280.e0000 0001 2180 6431National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228 Singapore
| | | | - Joris van Vugt
- Viatris, Aalsterweg 172, 5644 RH Eindhoven, The Netherlands
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Luque JS, Vargas M, Wallace K, Matthew OO, Tawk R, Ali AA, Kiros GE, Harris CM, Gwede CK. Engaging the Community on Colorectal Cancer Screening Education: Focus Group Discussions Among African Americans. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:251-262. [PMID: 33904120 PMCID: PMC8075366 DOI: 10.1007/s13187-021-02019-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 05/18/2023]
Abstract
Colorectal cancer (CRC) is the third most diagnosed cancer in the USA, and African Americans experience disproportionate CRC diagnosis and mortality. Early detection could reduce CRC incidence and mortality, and reduce CRC health disparities, which may be due in part to lower screening adherence and later stage diagnosis among African Americans compared to whites. Culturally tailored interventions to increase access to and uptake of CRC stool-based tests are one effective strategy to increase benefits of screening among African Americans. The objectives of this study were to obtain feedback from African Americans on CRC educational materials being developed for a subsequent behavioral clinical trial and explore participants' knowledge, attitudes, and beliefs about CRC and CRC screening. Seven focus groups were conducted between February and November 2020. Participants were African Americans recruited through community contacts. Four focus groups were held in-person and three were conducted virtually due to Covid-19 restrictions. Participants ranked CRC educational text messages and provided feedback on a culturally tailored educational brochure. A focus group guide with scripted probes was used to elicit discussion and transcripts were analyzed using traditional content analysis. Forty-two African Americans participated. Four themes were identified from focus group discussions: (1) knowledge, attitudes, and beliefs on CRC and CRC screening; (2) reliable sources of cancer education information; (3) cultural factors affecting perspectives on health; and (4) community insights into cancer education. Participant input on the brochure was incorporated in content creation. Engaging African American community members to qualitatively examine cancer prevention has value in improving implementation strategy and planning for behavioral clinical trials.
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Affiliation(s)
- John S Luque
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA.
| | - Matthew Vargas
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Kristin Wallace
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA
- Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Olayemi O Matthew
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Rima Tawk
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Askal A Ali
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Gebre-Egziabher Kiros
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Cynthia M Harris
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Clement K Gwede
- Moffitt Cancer Center and University of South Florida, 12902 Magnolia Dr., FOW-EDU, Tampa, FL, 33612, USA
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Baggett TP, Barbosa Teixeira J, Rodriguez EC, Anandakugan N, Sporn N, Chang Y, Percac-Lima S, Park ER, Rigotti NA. Patient navigation to promote lung cancer screening in a community health center for people experiencing homelessness: Protocol for a pragmatic randomized controlled trial. Contemp Clin Trials 2022; 113:106666. [PMID: 34971796 DOI: 10.1016/j.cct.2021.106666] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/13/2021] [Accepted: 12/23/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Lung cancer is a major cause of death among people experiencing homelessness, with mortality rates more than double those in the general population. Lung cancer screening (LCS) with low-dose computed tomography (LDCT) could reduce lung cancer deaths in this population, although the circumstances of homelessness present multiple barriers to LCS LDCT completion. Patient navigation is a promising strategy for overcoming these barriers. METHODS The Investigating Navigation to Help Advance Lung Equity (INHALE) Study is a pragmatic randomized controlled trial of patient navigation for LCS among individuals receiving primary care at Boston Health Care for the Homeless Program (BHCHP). Three hundred BHCHP patients who meet Medicare/Medicaid criteria for LCS will be randomized 2:1 to usual care with (n = 200) or without (n = 100) LCS navigation. Following a structured, theory-based protocol, the patient navigator assists with each step in the LCS process, providing lung cancer education, facilitating shared decision-making visits with primary care providers (PCPs), assisting in making and attending LCS LDCT appointments, arranging follow-up when needed, and offering tobacco cessation support for smokers. The primary outcome is receipt of LCS LDCT at 6 months. Using a sequential explanatory mixed methods approach, qualitative interviews with participants and PCPs will aid in interpreting and contextualizing the trial results. DISCUSSION This trial will produce the first experimental evidence on patient navigation for cancer screening in a homeless health care setting. Results could inform cancer health equity efforts at the 299 Health Care for the Homeless programs that serve over 900,000 patients annually in the US.
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Affiliation(s)
- Travis P Baggett
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Institute for Research, Quality & Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, MA, United States of America.
| | - Joana Barbosa Teixeira
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Elijah C Rodriguez
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; New York University Grossman School of Medicine, New York, NY, United States of America
| | - Nillani Anandakugan
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Nora Sporn
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Sanja Percac-Lima
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Elyse R Park
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Nancy A Rigotti
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
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15
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Coronado GD, Rawlings AM, Petrik AF, Slaughter M, Johnson ES, Hannon PA, Cole A, Vu T, Mummadi RR. Precision Patient Navigation to Improve Rates of Follow-up Colonoscopy, An Individual Randomized Effectiveness Trial. Cancer Epidemiol Biomarkers Prev 2021; 30:2327-2333. [PMID: 34583969 PMCID: PMC9273475 DOI: 10.1158/1055-9965.epi-20-1793] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/17/2021] [Accepted: 09/22/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Colorectal cancer screening by annual fecal immunochemical test (FIT) with follow-up on abnormal results is a cost-effective strategy to reduce colorectal cancer incidence and mortality. Unfortunately, many patients with abnormal results do not complete a follow-up colonoscopy. We tested whether navigation targeted to patients who are unlikely to complete the procedure may improve adherence and long-term outcomes. METHODS Study participants were patients at a large, integrated health system (Kaiser Permanente Northwest) who were ages 50 to 75 and were due for a follow-up colonoscopy after a recent abnormal FIT result. Probability of adherence to follow-up was estimated at baseline using a predictive risk model. Patients whose probability was 70% or lower were randomized to receive patient navigation or usual care, with randomization stratified by probability category (<50%, 50% < 60%, 60% < 65%, 65% ≤ 70%). We compared colonoscopy completion within 6 months between the navigation and usual care groups using Cox proportional hazards regression. RESULTS Participants (n = 415; 200 assigned to patient navigation, 215 to usual care) had a mean age of 62 years, 54% were female, and 87% were non-Hispanic white. By 6 months, 76% of the patient navigation group had completed a colonoscopy, compared with 65% of the usual care group (HR = 1.35; 95% confidence interval, 1.07-1.72; log-rank P value = 0.027). CONCLUSIONS In this randomized trial, patient navigation led to improvements in follow-up colonoscopy adherence. IMPACT More research is needed to assess the value of precision-directed navigation programs.
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Affiliation(s)
- Gloria D Coronado
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
| | - Andreea M Rawlings
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Amanda F Petrik
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Matthew Slaughter
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Eric S Johnson
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
- Northwest Permanente Medicine, Portland, Oregon
| | - Peggy A Hannon
- University of Washington School of Public Health, Seattle, Washington
| | - Allison Cole
- University of Washington School of Public Health, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Thuy Vu
- University of Washington School of Public Health, Seattle, Washington
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Malo TL, Correa SY, Moore AA, Ferrari RM, Leeman J, Brenner AT, Wheeler SB, Tan X, Reuland DS. Centralized colorectal cancer screening outreach and patient navigation for vulnerable populations in North Carolina: study protocol for the SCORE randomized controlled trial. Implement Sci Commun 2021; 2:113. [PMID: 34620250 PMCID: PMC8499575 DOI: 10.1186/s43058-021-00194-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/31/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Although colorectal cancer (CRC) screening is effective in reducing CRC mortality, screening rates in vulnerable populations served by community health centers (CHCs) remain below national targets. CHCs in North Carolina are challenged to reach CRC screening targets as they tend to be under-resourced, have limited capacity to implement and sustain population health interventions, and typically operate independently from one another and from regional colonoscopy providers. The Scaling Colorectal Cancer Screening Through Outreach, Referral, and Engagement (SCORE) project is designed to address barriers to CRC screening in partnership with CHCs by implementing a multilevel intervention that includes centralized support infrastructure for mailed fecal immunochemical test (FIT) outreach and patient navigation to follow-up colonoscopy. This paper describes protocols for the SCORE implementation trial. METHODS We will conduct a type 2 hybrid effectiveness-implementation trial that will assess effectiveness at increasing CRC screening and follow-up rates while also assessing implementation outcomes. The planned trial sample will include 4000 CHC patients who are at average CRC risk and due for screening. Participants will be randomized 1:1 to receive either usual care or a multilevel intervention that includes mailed FIT outreach and patient navigation support to follow-up colonoscopy for those with abnormal FIT. The primary effectiveness outcome is completion of any CRC screening test at six months after randomization. We will also conduct a multilevel assessment of implementation outcomes and determinants. DISCUSSION This hybrid effectiveness-implementation trial will evaluate the effectiveness and implementation of an intervention that provides centralized infrastructure for mailed FIT screening and patient navigation for CHCs that operate independently of other healthcare facilities. Findings from this research will enhance understanding of the effectiveness of a centralized approach and factors that determine successful implementation in vulnerable patient populations. TRIAL REGISTRATION The trial was registered on May 28, 2020, at ClinicalTrials.gov (identifier NCT04406714).
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Affiliation(s)
- Teri L. Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599 USA
| | - Sara Y. Correa
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599 USA
| | - Alexis A. Moore
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599 USA
| | - Renée M. Ferrari
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599 USA
| | - Jennifer Leeman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599 USA
- School of Nursing, University of North Carolina at Chapel Hill, 120 North Medical Drive, Chapel Hill, NC 27599 USA
| | - Alison T. Brenner
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599 USA
- School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC 27599 USA
| | - Stephanie B. Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599 USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599 USA
| | - Xianming Tan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599 USA
| | - Daniel S. Reuland
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599 USA
- School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC 27599 USA
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Mistry SK, Harris E, Harris M. Community Health Workers as Healthcare Navigators in Primary Care Chronic Disease Management: a Systematic Review. J Gen Intern Med 2021; 36:2755-2771. [PMID: 33674916 PMCID: PMC8390732 DOI: 10.1007/s11606-021-06667-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND This review was carried out to synthesize the evidence of the effectiveness of community health worker (CHW) navigation in primary care chronic disease management. METHODS We searched the English language literature between January 1990 and March 2020 in Medline, Embase, Emcare, PubMed, Psych Info, CINAHL, Scopus, and Medline Epub ahead of print. Data extraction, quality rating, and assessment of the reporting of interventions were performed by two reviewers independently and the findings were synthesized narratively. RESULTS Twenty-nine articles met the inclusion criteria. All but two were carried out in the USA and half were randomized controlled trials. Six of the 29 studies were of strong methodological quality while 12 were moderate and 11 weak. Overall, CHW navigation interventions were effective in increasing adherence to cancer screening and improving use of primary care for chronic disease management. There was insufficient evidence that they improved clinical outcomes or risk factors and reduced use of secondary or tertiary care or that they were cost-effective. However, criteria for recruitment, duration, and mode of training and supervision arrangements varied greatly between studies. DISCUSSION CHW navigation interventions improved aspects of chronic disease management. However, there is insufficient evidence of the impact on patient experience, clinical outcomes, or cost-effectiveness of the interventions. Future research should focus on standardizing organizational components of the CHW navigation interventions and evaluating their cost-effectiveness. PROTOCOL REGISTRATION The review protocol was published in PROSPERO (CRD42020153921).
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Affiliation(s)
- Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
| | - Elizabeth Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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Hyams T, Mueller N, Curbow B, King-Marshall E, Sultan S. Screening for colorectal cancer in people ages 45-49: research gaps, challenges and future directions for research and practice. Transl Behav Med 2021; 12:198-202. [PMID: 34184736 DOI: 10.1093/tbm/ibab079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Travis Hyams
- National Cancer Institute, Division of Cancer Control and Population Sciences, Office of the Director, Rockville, MD, USA.,Department of Behavioral and Community Health, University of Maryland, College Park, School of Public Health, College Park, MD USA
| | - Nora Mueller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Barbara Curbow
- Department of Behavioral and Community Health, University of Maryland, College Park, School of Public Health, College Park, MD USA
| | - Evelyn King-Marshall
- Department of Behavioral and Community Health, University of Maryland, College Park, School of Public Health, College Park, MD USA
| | - Shahnaz Sultan
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN, USA
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Roy S, Dickey S, Wang HL, Washington A, Polo R, Gwede CK, Luque JS. Systematic Review of Interventions to Increase Stool Blood Colorectal Cancer Screening in African Americans. J Community Health 2021; 46:232-244. [PMID: 32583358 PMCID: PMC7313439 DOI: 10.1007/s10900-020-00867-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
African Americans experience colorectal cancer (CRC) related disparities compared to other racial groups in the United States. African Americans are frequently diagnosed with CRC at a later stage, screening is underutilized, and mortality rates are highest in this group. This systematic review focused on intervention studies using stool blood CRC screening among African Americans in primary care and community settings. Given wide accessibility, low cost, and ease of dissemination of stool-based CRC screening tests, this review aims to determine effective interventions to improve participation rates. This systematic review included intervention studies published between January 1, 2000 and March 16, 2019. After reviewing an initial search of 650 studies, 11 studies were eventually included in this review. The included studies were studies conducted in community and clinical settings, using both inreach and outreach strategies to increase CRC screening. For each study, an unadjusted odds ratio (OR) for the CRC screening intervention compared to the control arm was calculated based on the data in each study to report effectiveness. The eleven studies together recruited a total of 3334 participants. The five studies using two-arm experimental designs ranged in effectiveness with ORs ranging from 1.1 to 13.0 using interventions such as mailed reminders, patient navigation, and tailored educational materials. Effective strategies to increase stool blood testing included mailed stool blood tests augmented by patient navigation, tailored educational materials, and follow-up calls or mailings to increase trust in the patient-provider relationship. More studies are needed on stool blood testing interventions to determine effectiveness in this population.
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Affiliation(s)
- Siddhartha Roy
- Department of Family and Community Medicine, Pennsylvania State University Health Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Cancer Control, Penn State Cancer Institute, Hershey, PA, USA
| | - Sabrina Dickey
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Hsiao-Lan Wang
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - Alexandria Washington
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1415 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Randy Polo
- University Libraries, University of South Florida, Tampa, FL, USA
| | - Clement K Gwede
- Division of Population Sciences, Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - John S Luque
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1415 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA.
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20
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Fendrick AM, Fisher DA, Saoud L, Ozbay AB, Karlitz JJ, Limburg PJ. Impact of Patient Adherence to Stool-Based Colorectal Cancer Screening and Colonoscopy Following a Positive Test on Clinical Outcomes. Cancer Prev Res (Phila) 2021; 14:845-850. [PMID: 34021023 PMCID: PMC8974412 DOI: 10.1158/1940-6207.capr-21-0075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/22/2021] [Accepted: 05/19/2021] [Indexed: 01/07/2023]
Abstract
Colorectal cancer-screening models commonly assume 100% adherence, which is inconsistent with real-world experience. The influence of adherence to initial stool-based screening [fecal immunochemical test (FIT), multitarget stool DNA (mt-sDNA)] and follow-up colonoscopy (after a positive stool test) on colorectal cancer outcomes was modeled using the Colorectal Cancer and Adenoma Incidence and Mortality Microsimulation Model. Average-risk individuals without diagnosed colorectal cancer at age 40 undergoing annual FIT or triennial mt-sDNA screening from ages 50 to 75 were simulated. Primary analyses incorporated published mt-sDNA (71%) or FIT (43%) screening adherence, with follow-up colonoscopy adherence ranging from 40% to 100%. Secondary analyses simulated 100% adherence for stool-based screening and colonoscopy follow-up (S1), published adherence for stool-based screening with 100% adherence to colonoscopy follow-up (S2), and published adherence for both stool-based screening and colonoscopy follow-up after positive mt-sDNA (73%) or FIT (47%; S3). Outcomes were life-years gained (LYG) and colorectal cancer incidence and mortality reductions (per 1,000 individuals) versus no screening. Adherence to colonoscopy follow-up after FIT had to be 4%-13% higher than mt-sDNA to reach equivalent LYG. The theoretical S1 favored FIT versus mt-sDNA (LYG 316 vs. 297; colorectal cancer incidence reduction 68% vs. 64%; colorectal cancer mortality reduction 76% vs. 72%). The more realistic S2 and S3 favored mt-sDNA versus FIT (S2: LYG 284 vs. 245, colorectal cancer incidence reduction 61% vs. 50%, colorectal cancer mortality reduction 69% vs. 59%; S3: LYG 203 vs. 113, colorectal cancer incidence reduction 43% vs. 23%, colorectal cancer mortality reduction 49% vs. 27%, respectively). Incorporating realistic adherence rates for colorectal cancer screening influences modeled outcomes and should be considered when assessing comparative effectiveness. PREVENTION RELEVANCE: Adherence rates for initial colorectal cancer screening by FIT or mt-sDNA and for colonoscopy follow-up of a positive initial test influence the comparative effectiveness of these screening strategies. Using adherence rates based on published data for stool-based testing and colonoscopy follow-up yielded superior outcomes with an mt-sDNA versus FIT-screening strategy.
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Affiliation(s)
- A. Mark Fendrick
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan.,Corresponding Author: A. Mark Fendrick, University of Michigan, 2800 Plymouth Road, Building 16/4th floor, Ann Arbor, MI 48109. Phone: 734-647-9688; Fax: 734-936-8944; E-mail:
| | - Deborah A. Fisher
- Division of Gastroenterology, Department of Medicine, Duke University, Durham, North Carolina
| | - Leila Saoud
- Exact Sciences Corporation, Madison, Wisconsin
| | | | - Jordan J. Karlitz
- Division of Gastroenterology, Department of Medicine, Denver Health Medical Center, Denver, Colorado
| | - Paul J. Limburg
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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21
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Housten AJ, Gunn CM, Paasche-Orlow MK, Basen-Engquist KM. Health Literacy Interventions in Cancer: a Systematic Review. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:240-252. [PMID: 33155097 PMCID: PMC8005416 DOI: 10.1007/s13187-020-01915-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 05/05/2023]
Abstract
Approximately one-third of adults in the United States (U.S.) have limited health literacy. Those with limited health literacy often have difficultly navigating the health care environment, including navigating care across the cancer continuum (e.g., prevention, screening, diagnosis, treatment). Evidence-based interventions to assist adults with limited health literacy improve health outcomes; however, little is known about health literacy interventions in the context of cancer and their impact on cancer-specific health outcomes. The purpose of this review was to identify and characterize the literature on health literacy interventions across the cancer care continuum. Specifically, our aim was to review the strength of evidence, outcomes assessed, and intervention modalities within the existing literature reporting health literacy interventions in cancer. Our search yielded 1036 records (prevention/screening n = 174; diagnosis/treatment n = 862). Following deduplication and review for inclusion criteria, we analyzed 87 records of intervention studies reporting health literacy outcomes, including 45 pilot studies (prevention/screening n = 24; diagnosis/treatment n = 21) and 42 randomized controlled trials or quasi-experimental trials (prevention/screening n = 31; diagnosis/treatment n = 11). This literature included 36 unique interventions (prevention/screening n = 28; diagnosis/treatment n = 8), mostly in the formative stages of intervention development, with few assessments of evidence-based interventions. These gaps in the literature necessitate further research in the development and implementation of evidence-based health literacy interventions to improve cancer outcomes.
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Affiliation(s)
- A J Housten
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, 660 S. Euclid Ave. Campus Box 8100, St. Louis, MO, 63110, USA.
| | - C M Gunn
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - M K Paasche-Orlow
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - K M Basen-Engquist
- Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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22
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Liu D, Schuchard H, Burston B, Yamashita T, Albert S. Interventions to Reduce Healthcare Disparities in Cancer Screening Among Minority Adults: a Systematic Review. J Racial Ethn Health Disparities 2021; 8:107-126. [PMID: 32415578 DOI: 10.1007/s40615-020-00763-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 12/16/2019] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Racial minority populations face an increased burden relative to cancer interventions. Compared with Caucasians, the cancer screening rate is substantially lower among African American, Asian American, Latinx American, and American Indian/Alaska Native populations. Barriers such as low health literacy, lack of health insurance, and miscommunication between patients and providers have been identified as important factors that result in low screening rates among minority adults. This study was designed to identify interventions targeting racial minority adults 40 years of age or older that were effective in increasing cancer screening uptake rates. METHODS A systematic review of articles published in and after January 2009 was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Twenty-six published studies of cancer screening intervention tested with minority adults were identified through the searches of CINAHL, Global Health, PsycINFO, PubMed, and Scopus databases. RESULTS Thirteen (50%) of the studies utilized lay community health workers to increase cancer awareness and knowledge and to encourage screening. These methods took place over the telephone, at community education sessions, or within the context of personalized patient navigation support. The intervention programs utilized culturally relevant materials as well as spoken and written information in the targeted population's native language. Various intervention designs resulted in statistically significant increases in cancer screening adherence. However, we found no intervention that consistently elevated cancer screening rates across all racial/ethnic minority adults. CONCLUSIONS The finding suggests that highly segmented interventions are needed in order to improve cancer screening among various racial/ethnic minority adults.
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Affiliation(s)
- Darren Liu
- Department of Public Health, Des Moines University, 3200 Grand Avenue, Des Moines, IA, 50312, USA.
| | - Hayley Schuchard
- College of Osteopathic Medicine, Des Moines University, Des Moines, IA, USA
| | - Betty Burston
- Department of Health Care Administration and Policy, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Takashi Yamashita
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - Steven Albert
- Department of Behavioral & Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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23
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Piscitello A, Saoud L, Fendrick AM, Borah BJ, Hassmiller Lich K, Matney M, Ozbay AB, Parton M, Limburg PJ. Estimating the impact of differential adherence on the comparative effectiveness of stool-based colorectal cancer screening using the CRC-AIM microsimulation model. PLoS One 2020; 15:e0244431. [PMID: 33373409 PMCID: PMC7771985 DOI: 10.1371/journal.pone.0244431] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Real-world adherence to colorectal cancer (CRC) screening strategies is imperfect. The CRC-AIM microsimulation model was used to estimate the impact of imperfect adherence on the relative benefits and burdens of guideline-endorsed, stool-based screening strategies. METHODS Predicted outcomes of multi-target stool DNA (mt-sDNA), fecal immunochemical tests (FIT), and high-sensitivity guaiac-based fecal occult blood tests (HSgFOBT) were simulated for 40-year-olds free of diagnosed CRC. For robustness, imperfect adherence was incorporated in multiple ways and with extensive sensitivity analysis. Analysis 1 assumed adherence from 0%-100%, in 10% increments. Analysis 2 longitudinally applied real-world first-round differential adherence rates (base-case imperfect rates = 40% annual FIT vs 34% annual HSgFOBT vs 70% triennial mt-sDNA). Analysis 3 randomly assigned individuals to receive 1, 5, or 9 lifetime (9 = 100% adherence) mt-sDNA tests and 1, 5, or 9 to 26 (26 = 100% adherence) FIT tests. Outcomes are reported per 1000 individuals compared with no screening. RESULTS Each screening strategy decreased CRC incidence and mortality versus no screening. In individuals screened between ages 50-75 and adherence ranging from 10%a-100%, the life-years gained (LYG) for triennial mt-sDNA ranged from 133.1-300.0, for annual FIT from 96.3-318.1, and for annual HSgFOBT from 99.8-320.6. At base-case imperfect adherence rates, mt-sDNA resulted in 19.1% more LYG versus FIT, 25.4% more LYG versus HSgFOBT, and generally had preferable efficiency ratios while offering the most LYG. Completion of at least 21 FIT tests is needed to reach approximately the same LYG achieved with 9 mt-sDNA tests. CONCLUSIONS Adherence assumptions affect the conclusions of CRC screening microsimulations that are used to inform CRC screening guidelines. LYG from FIT and HSgFOBT are more sensitive to changes in adherence assumptions than mt-sDNA because they require more tests be completed for equivalent benefit. At imperfect adherence rates, mt-sDNA provides more LYG than FIT or HSgFOBT at an acceptable tradeoff in screening burden.
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Affiliation(s)
| | - Leila Saoud
- Exact Sciences Corporation, Madison, WI, United States of America
| | - A. Mark Fendrick
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI, United States of America
| | - Bijan J. Borah
- Department of Health Services Research, Mayo Clinic, Rochester, MN, United States of America
| | - Kristen Hassmiller Lich
- Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Michael Matney
- Exact Sciences Corporation, Madison, WI, United States of America
| | - A. Burak Ozbay
- Exact Sciences Corporation, Madison, WI, United States of America
| | - Marcus Parton
- Exact Sciences Corporation, Madison, WI, United States of America
| | - Paul J. Limburg
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States of America
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24
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Nelson HD, Cantor A, Wagner J, Jungbauer R, Fu R, Kondo K, Stillman L, Quiñones A. Effectiveness of Patient Navigation to Increase Cancer Screening in Populations Adversely Affected by Health Disparities: a Meta-analysis. J Gen Intern Med 2020; 35:3026-3035. [PMID: 32700218 PMCID: PMC7573022 DOI: 10.1007/s11606-020-06020-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/30/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study evaluates the effectiveness of patient navigation to increase screening for colorectal, breast, and cervical cancer in populations adversely affected by health care disparities. METHODS Eligible studies were identified through English-language searches of Ovid® MEDLINE®, PsycINFO®, SocINDEX, and Veterans Affairs Health Services database (January 1, 1996, to July 5, 2019) and manual review of reference lists. Randomized trials and observational studies of relevant populations that evaluated the effectiveness of patient navigation on screening rates for colorectal, breast, or cervical cancer compared with usual or alternative care comparison groups were included. Two investigators independently abstracted study data and assessed study quality and applicability using criteria adapted from the U.S. Preventive Services Task Force. Discrepancies were resolved by consensus with a third reviewer. Results were combined using profile likelihood random effects models. RESULTS Thirty-seven studies met inclusion criteria (28 colorectal, 11 breast, 4 cervical cancers including 3 trials with multiple cancer types). Screening rates were higher with patient navigation for colorectal cancer overall (risk ratio [RR] 1.64; 95% confidence interval [CI] 1.42 to 1.92; I2 = 93.7%; 22 trials) and by type of test (fecal occult blood or immunohistochemistry testing [RR 1.69; 95% CI 1.33 to 2.15; I2 = 80.5%; 6 trials]; colonoscopy/endoscopy [RR 2.08; 95% CI 1.08 to 4.56; I2 = 94.6%; 6 trials]). Screening was also higher with navigation for breast cancer (RR 1.50; 95% CI 1.22 to 1.91; I2 = 98.6%; 10 trials) and cervical cancer (RR 1.11; 95% CI 1.05 to 1.19; based on the largest trial). The high heterogeneity of cervical cancer studies prohibited meta-analysis. Results were similar for colorectal and breast cancer regardless of prior adherence to screening guidelines, follow-up time, and study quality. CONCLUSIONS In populations adversely affected by disparities, colorectal, breast, and cervical cancer screening rates were higher in patients provided navigation services. Registration: PROSPERO: CRD42018109263.
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Affiliation(s)
- Heidi D Nelson
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA. .,Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Amy Cantor
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.,Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jesse Wagner
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Rebecca Jungbauer
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Rongwei Fu
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.,School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
| | - Karli Kondo
- Evidence-based Synthesis Program, Portland VA Health Care System, Portland, OR, USA.,Office of Research Integrity, Oregon Health & Science University, Portland, OR, USA
| | - Lucy Stillman
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Ana Quiñones
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
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25
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Rogers CR, Matthews P, Xu L, Boucher K, Riley C, Huntington M, Le Duc N, Okuyemi KS, Foster MJ. Interventions for increasing colorectal cancer screening uptake among African-American men: A systematic review and meta-analysis. PLoS One 2020; 15:e0238354. [PMID: 32936812 PMCID: PMC7494124 DOI: 10.1371/journal.pone.0238354] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 08/07/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND African-American men have the lowest 5-year survival rate in the U.S. for colorectal cancer (CRC) of any racial group, which may partly stem from low screening adherence. It is imperative to synthesize the literature evaluating the effectiveness of interventions on CRC screening uptake in this population. MATERIALS AND METHODS In this systematic review and meta-analysis, Medline, CINAHL, Embase, and Cochrane CENTRAL were searched for U.S.-based interventions that: were published after 1998-January 2020; included African-American men; and evaluated CRC screening uptake explicitly. Checklist by Cochrane Collaboration and Joanna Brigg were utilized to assess risk of bias, and meta-regression and sensitivity analyses were employed to identify the most effective interventions. RESULTS Our final sample comprised 41 studies with 2 focused exclusively on African-American men. The most frequently adopted interventions were educational materials (39%), stool-based screening kits (14%), and patient navigation (11%). Most randomized controlled trials failed to provide details about the blinding of the participant recruitment method, allocation concealment method, and/or the outcome assessment. Due to high heterogeneity, meta-analysis was conducted among 17 eligible studies. Interventions utilizing stool-based kits or patient navigation were most effective at increasing CRC screening completion, with odds ratios of 9.60 (95% CI 2.89-31.82, p = 0.0002) and 2.84 (95% CI 1.23-6.49, p = 0.01). No evidence of publication bias was present for this study registered with the International Prospective Registry of Systematic Reviews (PROSPERO 2019 CRD42019119510). CONCLUSIONS Additional research is warranted to uncover effective, affordable interventions focused on increasing CRC screening completion among African-American men. When designing and implementing future multicomponent interventions, employing 4 or fewer interventions types may reduce bias risk. Since only 5% of the interventions solely focused on African-American men, future theory-driven interventions should consider recruiting samples comprised solely of this population.
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Affiliation(s)
- Charles R. Rogers
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Phung Matthews
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Lei Xu
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, United States of America
| | - Kenneth Boucher
- Cancer Biostatistics Shared Resource, Huntsman Cancer Institute, Salt Lake City, UT, United States of America
| | - Colin Riley
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Matthew Huntington
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Nathan Le Duc
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Kola S. Okuyemi
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Margaret J. Foster
- Medical Sciences Library, Texas A&M University, College Station, TX, United States of America
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26
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Mendelsohn RB, DeLeon SF, Calo D, Villegas S, Carlesimo M, Wang JJ, Winawer SJ. Feasibility of Patient Navigation and Impact on Adherence to Screening Colonoscopy in a Large Diverse Urban Population. J Racial Ethn Health Disparities 2020; 8:559-565. [PMID: 32643126 DOI: 10.1007/s40615-020-00812-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Disparities observed in colorectal cancer (CRC) incidence and mortality among blacks and Hispanics compared with whites may be in part due to lower screening rates. The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) has implemented a patient navigator (PN) program at NYC hospitals serving lower-income patients to promote high adherence by patients referred for screening colonoscopy. A prior study showed this PN program increased adherence at 3 public hospitals. The aim of this study was to determine the feasibility of expanding the PN program to 10 hospital sites by assessing the impact of the PN program on adherence to screening colonoscopy in a large, urban, lower-income population. METHODS Data were collected from 2007 through the first quarter of 2012 from PN sites. One site also contributed data from the pilot phase of the project, from 2005 to 2006. Adherence to scheduled screening colonoscopy among those ≥ 50 years was assessed among 10 hospital sites in NYC participating in the colonoscopy PN program. RESULTS Among the 37,077 asymptomatic adults ≥ 50 years who were scheduled for a screening colonoscopy from 2005 to the first quarter of 2012, 84.2% (83.2% of black, 84.9% of Hispanic, and 87.5% of white adults) were adherent to scheduled colonoscopy. CONCLUSIONS Expansion of PN programs to navigate all patients referred for a colonoscopy was feasible in a large, urban setting. This can be implemented resulting in high overall adherence rates to screening colonoscopies. The program likely did not result in large ethnic disparities.
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Affiliation(s)
- Robin B Mendelsohn
- Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue, New York, NY, 10065, USA.
| | | | - Delia Calo
- Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue, New York, NY, 10065, USA
| | - Sonia Villegas
- NYC Department of Health and Mental Hygiene, New York, NY, USA
| | - Mari Carlesimo
- NYC Department of Health and Mental Hygiene, New York, NY, USA
| | - Jason J Wang
- Hofstra Northwell School of Medicine, Department of Medicine, Hempstead, NY, USA
| | - Sidney J Winawer
- Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue, New York, NY, 10065, USA
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27
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White PM, Itzkowitz SH. Barriers Driving Racial Disparities in Colorectal Cancer Screening in African Americans. Curr Gastroenterol Rep 2020; 22:41. [PMID: 32647903 DOI: 10.1007/s11894-020-00776-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Colorectal cancer screening has been shown to decrease mortality from colorectal cancer. Screening disparities continue to exist among ethnic minorities, particularly for African Americans. We herein review the barriers of colorectal cancer screening in this population. RECENT FINDINGS At its foundation are patient barriers, which are further compounded by physician-related barriers and the idiosyncrasies of the healthcare system. Interventions to address the barriers include patient outreach, provider education, and healthcare legislation addressing financial barriers. Recent research has focused on factors predicting intentions to undergo colorectal cancer screening. Underlying all of the barriers is the systemic racism that affects and influences the healthcare system as much as all other institutions and contributes to inequities in the delivery of effective cancer prevention efforts. Perpetual disparities in CRC screening within the African American community are due to multifactorial barriers from the individual patient to provider and healthcare system and societal influences. An awareness of the behavioral and systemic factors that affect African Americans must underpin efforts to reach full equity in delivering CRC screening to this often medically underserved segment of our society.
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Affiliation(s)
- Pascale M White
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Box 1069, New York, NY, 10029, USA
| | - Steven H Itzkowitz
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Box 1069, New York, NY, 10029, USA.
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28
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Tsipa A, O'Connor DB, Branley-Bell D, Day F, Hall LH, Sykes-Muskett B, Wilding S, Taylor N, Conner M. Promoting colorectal cancer screening: a systematic review and meta-analysis of randomised controlled trials of interventions to increase uptake. Health Psychol Rev 2020; 15:371-394. [PMID: 32401175 DOI: 10.1080/17437199.2020.1760726] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Colorectal cancer (CRC) represents a global public health concern. CRC screening is associated with significant reductions in CRC incidence and mortality, however, uptake is suboptimal. This systematic review and meta-analysis of randomised controlled trials explored the effectiveness of interventions designed to increase screening uptake, plus the impact of various moderators. Data from 102 studies including 1.94 million participants were analysed. Results showed significant benefit of all interventions combined (OR, 1.49, 95% CI: 1.43, 1.56, p < 0.001). The effects were similar in studies using objective versus self-reported uptake measures and lower in studies judged to be at high risk of bias. Moderator analyses indicated significant effects for aspects of behaviour (effects lower for studies on non-endoscopic procedures), and intervention (effects higher for studies conducted in community settings, in healthcare systems that are not free, and that use reminders, health-professional providers, paper materials supplemented with in-person or phone contact, but avoid remote contact). Interventions that included behaviour change techniques targeting social support (unspecified or practical), instructions or demonstration of the behaviour, and that added objects to the environment produced stronger effects. The way in which findings can inform interventions to improve CRC screening uptake is discussed.
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Affiliation(s)
| | | | - Dawn Branley-Bell
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Fiona Day
- NHS Leeds West Clinical Commissioning Group, Leeds, UK
| | - Louise H Hall
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Sarah Wilding
- School of Psychology, University of Leeds, Leeds, UK
| | - Natalie Taylor
- Cancer Council New South Wales, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
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29
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Use of Patient Navigators to Reduce Barriers in Living Donation and Living Donor Transplantation. CURRENT TRANSPLANTATION REPORTS 2020. [DOI: 10.1007/s40472-020-00280-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nelson HD, Cantor A, Wagner J, Jungbauer R, Quiñones A, Stillman L, Kondo K. Achieving Health Equity in Preventive Services: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med 2020; 172:258-271. [PMID: 31931527 DOI: 10.7326/m19-3199] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Disadvantaged populations in the United States experience disparities in the use of preventive health services. PURPOSE To examine effects of barriers that create health disparities in 10 recommended preventive services for adults, and to evaluate the effectiveness of interventions to reduce them. DATA SOURCES English-language searches of Ovid MEDLINE, PsycINFO, SocINDEX, and the Veterans Affairs Health Services database (1 January 1996 to 5 July 2019); reference lists. STUDY SELECTION Trials, observational studies with comparison groups, and systematic reviews of populations adversely affected by disparities that reported effects of barriers on use of any of the 10 selected preventive services or that reported the effectiveness of interventions to reduce disparities in use of a preventive service by improving intermediate or clinical outcomes. DATA EXTRACTION Dual extraction and assessment of study quality, strength of evidence, and evidence applicability. DATA SYNTHESIS No studies reported effects of provider-specific barriers on preventive service use. Eighteen studies reporting effects of patient barriers, such as insurance coverage or lack of a regular provider, on preventive service use had mixed and inconclusive findings. Studies of patient-provider interventions (n = 12), health information technologies (n = 11), and health system interventions (n = 88) indicated higher cancer screening rates with patient navigation; telephone calls, prompts, and other outreach methods; reminders involving lay health workers; patient education; risk assessment, counseling, and decision aids; screening checklists; community engagement; and provider training. Single studies showed that clinician-delivered and technology-assisted interventions improved rates of smoking cessation and weight loss, respectively. LIMITATION Insufficient or low strength of evidence and applicability for most interventions except patient navigation, telephone calls and prompts, and reminders involving lay health workers. CONCLUSION In populations adversely affected by disparities, patient navigation, telephone calls and prompts, and reminders involving lay health workers increase cancer screening. PRIMARY FUNDING SOURCE National Institutes of Health Office of Disease Prevention through an interagency agreement with the Agency for Healthcare Research and Quality. (PROSPERO: CRD42018109263).
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Affiliation(s)
- Heidi D Nelson
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon (H.D.N., A.C., J.W., R.J., L.S.)
| | - Amy Cantor
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon (H.D.N., A.C., J.W., R.J., L.S.)
| | - Jesse Wagner
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon (H.D.N., A.C., J.W., R.J., L.S.)
| | - Rebecca Jungbauer
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon (H.D.N., A.C., J.W., R.J., L.S.)
| | - Ana Quiñones
- Oregon Health & Science University-Portland State University, Portland, Oregon (A.Q.)
| | - Lucy Stillman
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon (H.D.N., A.C., J.W., R.J., L.S.)
| | - Karli Kondo
- Portland VA Health Care System and Oregon Health & Science University, Portland, Oregon (K.K.)
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Temucin E, Nahcivan NO. The Effects of the Nurse Navigation Program in Promoting Colorectal Cancer Screening Behaviors: a Randomized Controlled Trial. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:112-124. [PMID: 30470978 DOI: 10.1007/s13187-018-1448-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Although screening programs are known and recommended for the early detection of colorectal cancer (CRC), the screening rates for the fecal occult blood test (FOBT) and colonoscopy are very low among adult individuals. Navigation programs, also known as individualized counseling, have recently begun to be used for increasing screening rates. The purpose of this study was to compare the efficacy of the Nurse Navigation Program versus usual care on CRC screening participation and movement in stage of adoption for CRC screening and to examine perceived benefits of and barriers to CRC screening. This study was designed in line with a pre- and posttest two-group methodology. A total of 110 participants (55 nurse-navigated and 55 non-navigated patients) were studied. Data were collected using the following three tools: a sociodemographic information form, the Harvard Colorectal Cancer Risk Assessment Tool, and Instruments to Measure Colorectal Cancer Screening Benefits and Barriers. Following the Nurse Navigation Program, the FOBT (82 and 84%, respectively) and colonoscopy completion rates (15 and 22%, respectively) were significantly higher in the nurse-navigated group than in the non-navigated group at 3 and 6 months follow-up. Following the program, the benefit perceptions of the nurse-navigated group about CRC screening were improved, and their barrier perceptions were reduced. The results showed that the Nurse Navigation Program had significant effects on CRC screening behavior and health-related beliefs concerning CRC screening. Further assessment of the Nurse Navigation Program in different groups should be performed to observe its effects.
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Affiliation(s)
- Elif Temucin
- Nursing Faculty, Oncology Nursing Department, University of Health Sciences, Istanbul, Turkey.
| | - Nursen O Nahcivan
- Florence Nightingale Nursing Faculty, Public Health Nursing Department, Istanbul University, Istanbul, Turkey
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Coronado GD, Johnson ES, Leo MC, Schneider JL, Smith D, Mummadi R, Petrik AF, Thompson JH, Jimenez R. Patient randomized trial of a targeted navigation program to improve rates of follow-up colonoscopy in community health centers. Contemp Clin Trials 2020; 89:105920. [PMID: 31881390 PMCID: PMC7254876 DOI: 10.1016/j.cct.2019.105920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/18/2019] [Accepted: 12/23/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) screening by annual fecal immunochemical test (FIT) is an accessible and cost-effective strategy to lower CRC incidence and mortality. However, this mode of screening depends on follow-up colonoscopy after a positive FIT result. Unfortunately, nearly one-half of FIT-positive patients fail to complete this essential screening component. Patient navigation may improve follow-up colonoscopy adherence. To deliver patient navigation cost-effectively, health centers could target navigation to patients who are unlikely to complete the procedure on their own. OBJECTIVES The Predicting and Addressing Colonoscopy Non-adherence in Community Settings (PRECISE) clinical trial will validate a risk model of follow-up colonoscopy adherence and test whether patient navigation raises rates of colonoscopy adherence overall and among patients in each probability stratum (low, moderate, and high probability of adherence without intervention). METHODS PRECISE is a collaboration with a large community health center whose patient population is 37% Latino. Eligible patients will be aged 50-75, have an abnormal FIT result in the past month, and be due for a follow-up colonoscopy. Patients will be randomized to patient navigation or usual care. Primary outcomes will be colonoscopy completion within one year of a positive FIT result, cost, and cost-effectiveness. Secondary outcomes will include time to colonoscopy receipt, adequacy of bowel prep, and communication of results to primary care providers. Primary and secondary outcomes will be reported overall and by probability stratum. DISCUSSION This innovative clinical trial will test the effectiveness and financial feasibility of using a precision health intervention to improve CRC screening completion in community health centers. TRIAL REGISTRATION National Clinical Trial (NCT) Identifier: NCT03925883.
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Affiliation(s)
- Gloria D Coronado
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
| | - Eric S Johnson
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Michael C Leo
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | | | - David Smith
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Raj Mummadi
- Northwest Permanente Medical Group, Portland, OR, USA
| | - Amanda F Petrik
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Jamie H Thompson
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
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Sharma N, Harris E, Lloyd J, Mistry SK, Harris M. Community health workers involvement in preventative care in primary healthcare: a systematic scoping review. BMJ Open 2019; 9:e031666. [PMID: 31852698 PMCID: PMC6937114 DOI: 10.1136/bmjopen-2019-031666] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 11/04/2019] [Accepted: 11/25/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To review effective models of community health worker (CHW) involvement in preventive care for disadvantaged culturally and linguistically diverse (CALD) patients in primary healthcare (PHC) that may be applicable to the Australian context. DESIGN Systematic scoping review. DATA SOURCES The studies were gathered through searching Medline, EMBASE, EMCARE, PsycINFO, CINAHL and online portals of relevant organisations. ELIGIBILITY CRITERIA All selected studies were original research studies which essentially evaluated preventive intervention undertake by CHWs in PHC. The intervened population were adults with or without diagnosed chronic health disease, culturally and linguistically diverse, or vulnerable due to geographic, economic and/or cultural characteristics that impede or compromise their access to healthcare. DATA EXTRACTION AND SYNTHESIS Data extraction was undertaken systematically in an excel spreadsheet while the findings were synthesised in a narrative manner. The quality appraisal of the selected studies was performed using effective public health practice project quality assessment tool. RESULTS A total of 1066 articles were identified during the initial search of six bibliographic databases. After screening the title, abstract and full text, 37 articles met the selection and methodological criteria and underwent data extraction. A high-quality evidence-base supporting the positive impact of CHWs supporting patients' access to healthcare and influencing positive behaviour change was found. Positive impacts of CHW interventions included improvements in clinical disease indicators, screening rates and behavioural change. Education-focused interventions were more effective in improving patient behaviour, whereas navigation interventions were most effective in improving access to services. Implementation was enhanced by cultural and linguistic congruence and specific training of CHWs in the intervention but reduced by short duration interventions, dropouts and poor adherence of patients. CONCLUSION The evidence generated from this systematic scoping review demonstrates the contribution of CHWs to improving access to preventive care for patients from CALD and disadvantaged backgrounds by providing both education and navigational interventions. More research is needed on CHW training and the incorporation of CHWs into primary health care (PHC) teams.
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Affiliation(s)
- Nila Sharma
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Elizabeth Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Jane Lloyd
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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Nalepinski DC. NAVIGATING THE CANCER EXPERIENCE. Cancer 2019. [DOI: 10.1002/9781119645214.ch8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Ishida K, Weiss E, Kee SA, Yingling CT. Increasing colorectal cancer screening orders using unlicensed assistive personnel. BMJ Open Qual 2019; 8:e000545. [PMID: 31321316 PMCID: PMC6606072 DOI: 10.1136/bmjoq-2018-000545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 05/02/2019] [Accepted: 06/01/2019] [Indexed: 11/29/2022] Open
Abstract
Background Colorectal cancer (CRC) is among the leading cancer diagnoses affecting both men and women worldwide. Prevention and early detection of CRC is possible by increasing access to and utilisation of screening tests. Although CRC screening is highly recommended, screening rates remain suboptimal in the USA, particularly among underserved populations. Our project site, an urban federally qualified health centre, was not meeting the national screening target of 80% of eligible adults. Objective The aim of this quality improvement project was to increase the number of orders for CRC screening to eligible patients by using unlicensed assistive personnel and automated telephone outreach calls to offer 100 patients CRC screening during an 8-week period. Methods 40 patients received outreach calls from care coordinators (CC). 40 patients received automated telephone call reminders to call a CC to obtain an order for CRC screening. 20 patients were offered CRC screening by a medical assistant (MA) as part of their scheduled office visits. We used two plan-do-study-act (PDSA) cycles to deliver these three screening interventions. Results A total of 100 patients received one of the interventions. Ten of those patients received an order for either colonoscopy or faecal immunochemical testing by the conclusion of the second PDSA cycle. The MA-offered screening resulted in the highest percentage of patients accepting CRC screenings and patients preferred this outreach approach compared with CC outreach or automated voice messages. CC outreach yielded a lower rate of accepted screenings. None of the patients who received the automated calls followed up to obtain a screening order. Conclusion Our project demonstrates that unlicensed assistive personnel have the potential to increase patient access to CRC screening.
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Affiliation(s)
- Kanako Ishida
- College of Nursing-Health Systems Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Erin Weiss
- College of Nursing-Health Systems Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Summer A Kee
- College of Nursing-Health Systems Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Charles T Yingling
- College of Nursing-Health Systems Science, University of Illinois at Chicago, Chicago, Illinois, USA
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Lopez D, Pratt-Chapman ML, Rohan EA, Sheldon LK, Basen-Engquist K, Kline R, Shulman LN, Flores EJ. Establishing effective patient navigation programs in oncology. Support Care Cancer 2019; 27:1985-1996. [PMID: 30887125 PMCID: PMC8811719 DOI: 10.1007/s00520-019-04739-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/07/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Recent advances in cancer treatment have resulted in greatly improved survival, and yet many patients in the USA have not benefited due to poor access to healthcare and difficulty accessing timely care across the cancer care continuum. Recognizing these issues and the need to facilitate discussions on how to improve navigation services for patients with cancer, the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine (NASEM) held a workshop entitled, "Establishing Effective Patient Navigation Programs in Oncology. The purpose of this manuscript is to disseminate the conclusions of this workshop while providing a clinically relevant review of patient navigation in oncology. DESIGN Narrative literature review and summary of workshop discussions RESULTS: Patient navigation has been shown to be effective at improving outcomes throughout the spectrum of cancer care. Work remains to develop consensus on scope of practice and evaluation criteria and to align payment incentives and policy. CONCLUSION Patient navigation plays an essential role in overcoming patient- and system-level barriers to improve access to cancer care and outcomes for those most in need.
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Affiliation(s)
| | | | | | | | | | - Ron Kline
- Centers for Medicare & Medicaid Innovation, Baltimore, MD, USA
| | - Lawrence N Shulman
- University of Pennsylvania Abramson Cancer Center, Philadelphia, PA, USA
| | - Efren J Flores
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA.
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37
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Bernardo BM, Zhang X, Beverly Hery CM, Meadows RJ, Paskett ED. The efficacy and cost-effectiveness of patient navigation programs across the cancer continuum: A systematic review. Cancer 2019; 125:2747-2761. [PMID: 31034604 DOI: 10.1002/cncr.32147] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/04/2019] [Accepted: 03/27/2019] [Indexed: 12/11/2022]
Abstract
Published studies regarding patient navigation (PN) and cancer were reviewed to assess quality, determine gaps, and identify avenues for future research. The PubMed and EMBASE databases were searched for studies investigating the efficacy and cost-effectiveness of PN across the cancer continuum. Each included article was scored independently by 2 separate reviewers with the Quality Assessment Tool for Quantitative Studies. The current review identified 113 published articles that assessed PN and cancer care, between August 1, 2010, and February 1, 2018, 14 of which reported on the cost-effectiveness of PN programs. Most publications focused on the effectiveness of PN in screening (50%) and diagnosis (27%) along the continuum of cancer care. Many described the effectiveness of PN for breast cancer (52%) or colorectal cancer outcomes (51%). Most studies reported favorable outcomes for PN programs, including increased uptake of and adherence to cancer screenings, timely diagnostic resolution and follow-up, higher completion rates for cancer therapy, and higher rates of attending medical appointments. Cost-effectiveness studies showed that PN programs yielded financial benefits. Quality assessment showed that 75 of the 113 included articles (65%) had 2 or more weak components. In conclusion, this review indicates numerous gaps within the PN and cancer literature where improvement is needed. For example, more research is needed at other points along the continuum of cancer care outside of screening and diagnosis. In addition, future research into the effectiveness of PN for understudied cancers outside of breast and colorectal cancer is necessary along with an assessment of cost-effectiveness and more rigorous reporting of study designs and results in published articles.
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Affiliation(s)
- Brittany M Bernardo
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Xiaochen Zhang
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Chloe M Beverly Hery
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Rachel J Meadows
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio
| | - Electra D Paskett
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio.,Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
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Drake BF, Lewis-Thames MW, Brown A, Rancilio D, Hicks V. An Evaluation of Follow-Up Activities of Participants From an Urban Prostate Cancer Screening Event. Am J Mens Health 2019; 13:1557988319844353. [PMID: 30982387 PMCID: PMC6463237 DOI: 10.1177/1557988319844353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study aims to evaluate follow-up activities completed by participants attending community prostate cancer (PCa) screening events. On-site surveys were collected from participants of 17 free PCa screening events from 2007 to 2011 in the St. Louis, MO metropolitan area. Follow-up action surveys were mailed to all on-site participants to assess medical (i.e., made an appointment with a doctor, got additional testing for PCa, made an appointment to be screened) and nonmedical activities (i.e., sought social support, health information-seeking, health behavior modifications) completed after the PCa screening event. Further, t tests and chi-square tests characterized participant information from the on-site survey and within each follow-up activity category for the mailed surveys. Among 1,088 on-site community PCa screening participants, the mean age was 50 years old, 94% were Black, and 30% responded to the mailed follow-up action survey. For the recorded follow-up activities, 65% of participants reported medically reported activities, of which “made an appointment to get a yearly physical” was the most common action (29%). Health behavior modifications were the most common nonmedically related activities (44%). Health information-seeking behaviors were the least reported follow-up action (22%). Men with higher incomes, married, with health insurance, and a primary care physician, most often participated in post-PSA screening activities, namely medically-related and social support activities. Understanding the most common activities completed by participants of a community PCa screening suggests the effectiveness of community events to re-engage underserved populations in the health-care system and provides insight on acceptable health promotion opportunities.
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Affiliation(s)
- Bettina F Drake
- 1 Department of Surgery, Washington University in St. Louis School of Medicine, Division of Public Health Sciences, St. Louis, MO, USA
| | - Marquita W Lewis-Thames
- 1 Department of Surgery, Washington University in St. Louis School of Medicine, Division of Public Health Sciences, St. Louis, MO, USA
| | | | - Danielle Rancilio
- 1 Department of Surgery, Washington University in St. Louis School of Medicine, Division of Public Health Sciences, St. Louis, MO, USA
| | - Veronica Hicks
- 1 Department of Surgery, Washington University in St. Louis School of Medicine, Division of Public Health Sciences, St. Louis, MO, USA
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Cykert S, Eng E, Manning MA, Robertson LB, Heron DE, Jones NS, Schaal JC, Lightfoot A, Zhou H, Yongue C, Gizlice Z. A Multi-faceted Intervention Aimed at Black-White Disparities in the Treatment of Early Stage Cancers: The ACCURE Pragmatic Quality Improvement trial. J Natl Med Assoc 2019; 112:468-477. [PMID: 30928088 DOI: 10.1016/j.jnma.2019.03.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Reports continue to show that Blacks with curable lung or breast cancer complete treatment less often than similar Whites contributing to worse survival. ACCURE is an intervention trial designed to address this problem. PATIENTS AND METHODS A pragmatic, quality improvement trial comparing an intervention group to retrospective and concurrent controls. Patients with early stage breast or lung cancer aged 18 to 85 were enrolled (N = 302) at 2 cancer centers between April 2013 and March 2015 for the intervention component. Data from patients seen between January 2007 and December 2012 with these diagnoses were obtained to establish control completion rates. Concurrent data for non-study patients were used to identify secular trends. The intervention included: a real time registry derived from electronic health records of participants to signal missed appointments or unmet care milestones, a navigator, and clinical feedback. The primary outcome was "Treatment Complete", a composite variable representing completion of surgery, recommended radiation and chemotherapy for each patient. RESULTS The mean age in the intervention group was 63.1 years; 37.1% of patients were Black. Treatment completion in retrospective and concurrent controls showed significant Black-White differences (Blacks (B) 79.8% vs. Whites (W) 87.3%, p < 0.001; 83.1% B vs. 90.1% W, p < 0.001, respectively). The disparity lessened within the intervention (B 88.4% and W 89.5%, p = 0.77). Multivariate analyses confirmed disparities reduction. OR for Black-White disparity within the intervention was 0.98 (95% CI 0.46-2.1); Black completion in the intervention compared favorably to Whites in retrospective (OR 1.6; 95% CI 0.90-2.9) and concurrent (OR 1.1; 95% CI 0.59-2.0) controls. CONCLUSION A real time registry combined with feedback and navigation improved completion of treatment for all breast and lung cancer patients and narrowed disparities. Similar multi-faceted interventions could mitigate disparities in the treatment of other cancers and chronic conditions.
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Affiliation(s)
- Samuel Cykert
- The University of North Carolina School of Medicine, 145 N Medical Drive CB# 7165, Chapel Hill, NC 27599, USA.
| | - Eugenia Eng
- Department of Health Behavior, The Gilling's School of Global Public Health, 360 Rosenau Hall, CB# 7440, Chapel Hill, NC 27599, USA
| | - Matthew A Manning
- Cone Health Cancer Center, 501 N Elam Ave, Greensboro, NC 27403, USA
| | - Linda B Robertson
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine 5150 Centre Avenue POB2 Cancer Pavilion, Room 438 Pittsburgh, PA 15232, USA
| | - Dwight E Heron
- Department of Radiation Oncology UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine5230 Centre Ave. Pittsburgh, PA 15232, USA
| | - Nora S Jones
- The Partnership Project, 301 S. Elm Street, Suite 414 Greensboro, NC 27401, USA
| | - Jennifer C Schaal
- The Partnership Project, 301 S. Elm Street, Suite 414 Greensboro, NC 27401, USA
| | - Alexandra Lightfoot
- Department of Health Behavior, The Gilling's School of Global Public Health 1700 Martin Luther King, Jr. Boulevard CB #7426, Chapel Hill, NC 27599, USA
| | - Haibo Zhou
- Department of Biostatistics, The Gilling's School of Global Public Health, The University of North Carolina at Chapel Hill, 3104C McGavran-Greenberg Hall, CB #7420, Chapel Hill, NC 27599, USA
| | - Christina Yongue
- Department of Public Health Education, University of North Carolina at Greensboro, P.O. Box 26170, Greensboro, NC 27402-6170, USA
| | - Ziya Gizlice
- Biostatistical Support Unit, The Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, CB# 7426, Chapel Hill NC 27599, USA
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Kwaan MR, Jones-Webb R. Colorectal Cancer Screening in Black Men: Recommendations for Best Practices. Am J Prev Med 2018; 55:S95-S102. [PMID: 30670207 DOI: 10.1016/j.amepre.2018.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/30/2018] [Accepted: 05/08/2018] [Indexed: 12/28/2022]
Abstract
Screening for colorectal cancer has been demonstrated to reduce colorectal cancer mortality. Blacks have a higher mortality from this malignancy, particularly men, yet screening rates in this population are often found to be lower than in whites. A modest literature demonstrates effective interventions that can increase screening rates in blacks; however, results are not consistent and ongoing work is required. Most work has not addressed specific barriers to screening in black men. Given the lack of studies on black men only, this study evaluated the state of research in the black population using a PubMed search. The authors provide commentary that proposes increased (1) state and local government support for collaborative programs with healthcare organizations, including patient navigation; (2) augmented community-organizing efforts to generate more attention to the need for colorectal cancer screening in the black community, with a focus on black men; and (3) federal research funding to promote investigation into new interventions and evaluation of existing ones. Specific recommendations for black men include lowering the screening age to 45years, increasing access to health care, the use of patient navigators, and improved reporting and monitoring of colorectal cancer screening rates. SUPPLEMENT INFORMATION: This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.
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Affiliation(s)
- Mary R Kwaan
- Department of Surgery, University California, Los Angeles, Los Angeles, California.
| | - Rhonda Jones-Webb
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
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Neal CD, Weaver DT, Raphel TJ, Lietz AP, Flores EJ, Percac-Lima S, Knudsen AB, Pandharipande PV. Patient Navigation to Improve Cancer Screening in Underserved Populations: Reported Experiences, Opportunities, and Challenges. J Am Coll Radiol 2018; 15:1565-1572. [DOI: 10.1016/j.jacr.2018.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/26/2018] [Accepted: 03/02/2018] [Indexed: 02/06/2023]
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Levin TR, Corley DA, Jensen CD, Schottinger JE, Quinn VP, Zauber AG, Lee JK, Zhao WK, Udaltsova N, Ghai NR, Lee AT, Quesenberry CP, Fireman BH, Doubeni CA. Effects of Organized Colorectal Cancer Screening on Cancer Incidence and Mortality in a Large Community-Based Population. Gastroenterology 2018; 155:1383-1391.e5. [PMID: 30031768 PMCID: PMC6240353 DOI: 10.1053/j.gastro.2018.07.017] [Citation(s) in RCA: 309] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/02/2018] [Accepted: 07/16/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Little information is available on the effectiveness of organized colorectal cancer (CRC) screening on screening uptake, incidence, and mortality in community-based populations. METHODS We contrasted screening rates, age-adjusted annual CRC incidence, and incidence-based mortality rates before (baseline year 2000) and after (through 2015) implementation of organized screening outreach, from 2007 through 2008 (primarily annual fecal immunochemical testing and colonoscopy), in a large community-based population. Among screening-eligible individuals 51-75 years old, we calculated annual up-to-date status for cancer screening (by fecal test, sigmoidoscopy, or colonoscopy), CRC incidence, cancer stage distributions, and incidence-based mortality. RESULTS Initiation of organized CRC screening significantly increased the up-to-date status of screening, from 38.9% in 2000 to 82.7% in 2015 (P < .01). Higher rates of screening were associated with a 25.5% reduction in annual CRC incidence between 2000 and 2015, from 95.8 to 71.4 cases/100,000 (P < .01), and a 52.4% reduction in cancer mortality, from 30.9 to 14.7 deaths/100,000 (P < .01). Increased screening was initially associated with increased CRC incidence, due largely to greater detection of early-stage cancers, followed by decreases in cancer incidence. Advanced-stage CRC incidence rates decreased 36.2%, from 45.9 to 29.3 cases/100,000 (P < .01), and early-stage CRC incidence rates decreased 14.5%, from 48.2 to 41.2 cases/100,000 (P < .04). CONCLUSIONS Implementing an organized CRC screening program in a large community-based population rapidly increased screening participation to the ≥80% target set by national organizations. Screening rates were sustainable and associated with substantial decreases in CRC incidence and mortality within short time intervals, consistent with early detection and cancer prevention.
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Affiliation(s)
- Theodore R. Levin
- Kaiser Permanente Medical Center, Walnut Creek, CA.,Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Joanne E. Schottinger
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Virginia P. Quinn
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Ann G. Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jeffrey K. Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Wei K. Zhao
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Natalia Udaltsova
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Nirupa R. Ghai
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Alexander T. Lee
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Bruce H. Fireman
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Chyke A. Doubeni
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Kelly C, Pericleous M, Hendy J, de Lusignan S, Ahmed A, Vandrevala T, Ala A. Interventions to improve the uptake of screening across a range of conditions in Ethnic Minority Groups: a systematic review. Int J Clin Pract 2018; 72:e13202. [PMID: 29920875 DOI: 10.1111/ijcp.13202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 04/15/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Screening programmes are well established in cancer, and are now being implemented in other conditions. An effective screening programme leads to early disease detection and improved outcomes but its impact is dependent on the quality of the test and the proportion of the target population participating. A further consideration is that uptake of screening by minority groups is low. PURPOSE To determine which interventions have successfully increased screening uptake amongst minorities. DATA SOURCES Medline, Cochrane database and the grey literature were searched from 1990 to 1st March 2016. STUDY SELECTION Fifty-five English language studies that assessed uptake of screening in any minority population in the country of study aged over 18 years and that included a comparison arm. DATA EXTRACTION Independent data extraction was undertaken by two researchers (CK and MP), using a predesigned data extraction form (DEF) which assisted retrieval of the core contents of each study and the organisation of material. DATA SYNTHESIS Evidence was organised by screening test and type of intervention. Two authors (CK and MP) extracted data into evidence tables to enable comparison of study characteristics and findings. The heterogeneity of methods precluded a meta-analysis thus results are descriptive. Evidence was also assessed, using the Cochrane Collaboration risk of bias tables. RESULTS This systematic review appraises data from international studies on a variety of minority groups, interventions and screening programmes providing a narrative review of their success and limitations.
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Affiliation(s)
- Claire Kelly
- Department of Gastroenterology and Hepatology, Royal Surrey County Hospital, Guildford, Surrey, UK
- Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford, Surrey, UK
| | - Marinos Pericleous
- Department of Gastroenterology and Hepatology, Royal Surrey County Hospital, Guildford, Surrey, UK
- Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford, Surrey, UK
| | - Jane Hendy
- Brunel Business School, Brunel University, London, UK
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford, Surrey, UK
| | - Ayesha Ahmed
- Brunel Business School, Brunel University, London, UK
| | | | - Aftab Ala
- Department of Gastroenterology and Hepatology, Royal Surrey County Hospital, Guildford, Surrey, UK
- Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford, Surrey, UK
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Ajeesh S, Luis R. A Comprehensive Electronic Health Record Based Patient Navigation Module Including Technology Driven Colorectal Cancer Outreach and Education. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:627-633. [PMID: 28188568 DOI: 10.1007/s13187-017-1184-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The purpose of this concept paper is to propose an innovative multifaceted patient navigation module embedded in the Electronic Health Record (EHR) to address barriers to efficient and effective colorectal cancer (CRC) care. The EHR-based CRC patient navigation module will include several patient navigation features: (1) CRC screening registry; (2) patient navigation data, including CRC screening data, outcomes of patient navigation including navigation status (CRC screening referrals, fecal occult blood test (FOBT) completed, colonoscopy scheduled and completed, cancelations, reschedules, and no-shows); (3) CRC counseling aid; and 4) Web-based CRC education application including interactive features such as a standardized colonoscopy preparation guide, modifiable CRC risk factors, and links to existing resources. An essential component of health informatics is the use of EHR systems to not only provide a system for storing and retrieval of patient health data but can also be used to enhance patient decision-making both from a provider and patient perspective.
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Affiliation(s)
- Sunny Ajeesh
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Rustveld Luis
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, 77030, USA.
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Sunny A, Rustveld L. The Role of Patient Navigation on Colorectal Cancer Screening Completion and Education: a Review of the Literature. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:251-259. [PMID: 27878766 DOI: 10.1007/s13187-016-1140-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Although the general assumption is that patient navigation helps patients adhere to CRC screening recommendations, concrete evidence for its effectiveness is still currently under investigation. The present literature review was conducted to explore effectiveness of patient navigation and education on colorectal cancer (CRC) screening completion in medically underserved populations. Data collection included PubMed, Google Scholar, and Cochrane reviews searches. Study inclusion criteria included randomized controlled trials and prospective investigations that included an intervention and control group. Case series, brief communications, commentaries, case reports, and uncontrolled studies were excluded. Twenty-seven of the 36 studies screened for relevance were selected for inclusion. Most studies explored the utility of lay and clinic-based patient navigation. Others implemented interventions that included tailored messaging, and culturally and linguistically appropriate outreach and education efforts to meet CRC screening needs of medically underserved individuals. More recent studies have begun to conduct cost-effectiveness analyses of patient navigation programs that impacted CRC screening and completion. Peer-reviewed publications consistently indicate a positive impact of patient navigation programs on CRC screening completion, as well have provided preliminary evidence for their cost-effectiveness.
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Affiliation(s)
- Ajeesh Sunny
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Luis Rustveld
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA.
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DeGroff A, Schroy PC, Morrissey KG, Slotman B, Rohan EA, Bethel J, Murillo J, Ren W, Niwa S, Leadbetter S, Joseph D. Patient Navigation for Colonoscopy Completion: Results of an RCT. Am J Prev Med 2017; 53:363-372. [PMID: 28676254 PMCID: PMC8855664 DOI: 10.1016/j.amepre.2017.05.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 04/11/2017] [Accepted: 05/11/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Colorectal cancer is a leading cause of cancer-related death in the U.S. Although screening reduces colorectal cancer incidence and mortality, screening rates among U.S. adults remain less than optimal, especially among disadvantaged populations. This study examined the efficacy of patient navigation to increase colonoscopy screening. STUDY DESIGN RCT. SETTING/PARTICIPANTS A total of 843 low-income adults, primarily Hispanic and non-Hispanic blacks, aged 50-75 years referred for colonoscopy at Boston Medical Center were randomized into the intervention (n=429) or control (n=427) groups. Participants were enrolled between September 2012 and December 2014, with analysis following through 2015. INTERVENTION Two bilingual lay navigators provided individualized education and support to reduce patient barriers and facilitate colonoscopy completion. The intervention was delivered largely by telephone. MAIN OUTCOME MEASURE Colonoscopy completion within 6 months of study enrollment. RESULTS Colonoscopy completion was significantly higher for navigated patients (61.1%) than control group patients receiving usual care (53.2%, p=0.021). Based on regression analysis, the odds of completing a colonoscopy for navigated patients was one and a half times greater than for controls (95% CI=1.12, 2.03, p=0.007). There were no differences between navigated and control groups in regard to adequacy of bowel preparation (95.3% vs 97.3%, respectively). CONCLUSIONS Navigation significantly improved colonoscopy screening completion among a racially diverse, low-income population. Results contribute to mounting evidence demonstrating the efficacy of patient navigation in increasing colorectal cancer screening. Screening can be further enhanced when navigation is combined with other evidence-based practices implemented in healthcare systems and the community.
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Affiliation(s)
- Amy DeGroff
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Paul C Schroy
- Boston Medical Center, Gastroenterology, Boston, Massachusetts
| | | | | | - Elizabeth A Rohan
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Steven Leadbetter
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Djenaba Joseph
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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Tsai MH, Xirasagar S, de Groen PC. Persisting Racial Disparities in Colonoscopy Screening of Persons with a Family History of Colorectal Cancer. J Racial Ethn Health Disparities 2017; 5:737-746. [DOI: 10.1007/s40615-017-0418-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/19/2017] [Accepted: 07/25/2017] [Indexed: 12/24/2022]
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Cole H, Thompson HS, White M, Browne R, Trinh-Shevrin C, Braithwaite S, Fiscella K, Boutin-Foster C, Ravenell J. Community-Based, Preclinical Patient Navigation for Colorectal Cancer Screening Among Older Black Men Recruited From Barbershops: The MISTER B Trial. Am J Public Health 2017; 107:1433-1440. [PMID: 28727540 DOI: 10.2105/ajph.2017.303885] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To test the effectiveness of a preclinical, telephone-based patient navigation intervention to encourage colorectal cancer (CRC) screening among older Black men. METHODS We conducted a 3-parallel-arm, randomized trial among 731 self-identified Black men recruited at barbershops between 2010 and 2013 in New York City. Participants had to be aged 50 years or older, not be up-to-date on CRC screening, have uncontrolled high blood pressure, and have a working telephone. We randomized participants to 1 of 3 groups: (1) patient navigation by a community health worker for CRC screening (PN), (2) motivational interviewing for blood pressure control by a trained counselor (MINT), or (3) both interventions (PLUS). We assessed CRC screening completion at 6-month follow-up. RESULTS Intent-to-treat analysis revealed that participants in the navigation interventions were significantly more likely than those in the MINT-only group to be screened for CRC during the 6-month study period (17.5% of participants in PN, 17.8% in PLUS, 8.4% in MINT; P < .01). CONCLUSIONS Telephone-based preclinical patient navigation has the potential to be effective for older Black men. Our results indicate the importance of community-based health interventions for improving health among minority men.
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Affiliation(s)
- Helen Cole
- At the time of the study, Helen Cole was with the Division of Health Behavior, Department of Population Health, New York University School of Medicine, New York, NY. Hayley S. Thompson is with the Population Studies and Disparities Research Program, Communication and Behavioral Oncology, Karmanos Cancer Institute, Detroit, MI. Marilyn White and Ruth Browne are with the Arthur Ashe Institute for Urban Health, Brooklyn, NY. Chau Trinh-Shevrin, Scott Braithwaite, and Joseph Ravenell are with the Department of Population Health, New York University School of Medicine. Kevin Fiscella is with the Departments of Family Medicine and Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carla Boutin-Foster is with the Division of Clinical Epidemiology and Evaluative Sciences, Weill Cornell Medical Center, New York
| | - Hayley S Thompson
- At the time of the study, Helen Cole was with the Division of Health Behavior, Department of Population Health, New York University School of Medicine, New York, NY. Hayley S. Thompson is with the Population Studies and Disparities Research Program, Communication and Behavioral Oncology, Karmanos Cancer Institute, Detroit, MI. Marilyn White and Ruth Browne are with the Arthur Ashe Institute for Urban Health, Brooklyn, NY. Chau Trinh-Shevrin, Scott Braithwaite, and Joseph Ravenell are with the Department of Population Health, New York University School of Medicine. Kevin Fiscella is with the Departments of Family Medicine and Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carla Boutin-Foster is with the Division of Clinical Epidemiology and Evaluative Sciences, Weill Cornell Medical Center, New York
| | - Marilyn White
- At the time of the study, Helen Cole was with the Division of Health Behavior, Department of Population Health, New York University School of Medicine, New York, NY. Hayley S. Thompson is with the Population Studies and Disparities Research Program, Communication and Behavioral Oncology, Karmanos Cancer Institute, Detroit, MI. Marilyn White and Ruth Browne are with the Arthur Ashe Institute for Urban Health, Brooklyn, NY. Chau Trinh-Shevrin, Scott Braithwaite, and Joseph Ravenell are with the Department of Population Health, New York University School of Medicine. Kevin Fiscella is with the Departments of Family Medicine and Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carla Boutin-Foster is with the Division of Clinical Epidemiology and Evaluative Sciences, Weill Cornell Medical Center, New York
| | - Ruth Browne
- At the time of the study, Helen Cole was with the Division of Health Behavior, Department of Population Health, New York University School of Medicine, New York, NY. Hayley S. Thompson is with the Population Studies and Disparities Research Program, Communication and Behavioral Oncology, Karmanos Cancer Institute, Detroit, MI. Marilyn White and Ruth Browne are with the Arthur Ashe Institute for Urban Health, Brooklyn, NY. Chau Trinh-Shevrin, Scott Braithwaite, and Joseph Ravenell are with the Department of Population Health, New York University School of Medicine. Kevin Fiscella is with the Departments of Family Medicine and Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carla Boutin-Foster is with the Division of Clinical Epidemiology and Evaluative Sciences, Weill Cornell Medical Center, New York
| | - Chau Trinh-Shevrin
- At the time of the study, Helen Cole was with the Division of Health Behavior, Department of Population Health, New York University School of Medicine, New York, NY. Hayley S. Thompson is with the Population Studies and Disparities Research Program, Communication and Behavioral Oncology, Karmanos Cancer Institute, Detroit, MI. Marilyn White and Ruth Browne are with the Arthur Ashe Institute for Urban Health, Brooklyn, NY. Chau Trinh-Shevrin, Scott Braithwaite, and Joseph Ravenell are with the Department of Population Health, New York University School of Medicine. Kevin Fiscella is with the Departments of Family Medicine and Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carla Boutin-Foster is with the Division of Clinical Epidemiology and Evaluative Sciences, Weill Cornell Medical Center, New York
| | - Scott Braithwaite
- At the time of the study, Helen Cole was with the Division of Health Behavior, Department of Population Health, New York University School of Medicine, New York, NY. Hayley S. Thompson is with the Population Studies and Disparities Research Program, Communication and Behavioral Oncology, Karmanos Cancer Institute, Detroit, MI. Marilyn White and Ruth Browne are with the Arthur Ashe Institute for Urban Health, Brooklyn, NY. Chau Trinh-Shevrin, Scott Braithwaite, and Joseph Ravenell are with the Department of Population Health, New York University School of Medicine. Kevin Fiscella is with the Departments of Family Medicine and Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carla Boutin-Foster is with the Division of Clinical Epidemiology and Evaluative Sciences, Weill Cornell Medical Center, New York
| | - Kevin Fiscella
- At the time of the study, Helen Cole was with the Division of Health Behavior, Department of Population Health, New York University School of Medicine, New York, NY. Hayley S. Thompson is with the Population Studies and Disparities Research Program, Communication and Behavioral Oncology, Karmanos Cancer Institute, Detroit, MI. Marilyn White and Ruth Browne are with the Arthur Ashe Institute for Urban Health, Brooklyn, NY. Chau Trinh-Shevrin, Scott Braithwaite, and Joseph Ravenell are with the Department of Population Health, New York University School of Medicine. Kevin Fiscella is with the Departments of Family Medicine and Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carla Boutin-Foster is with the Division of Clinical Epidemiology and Evaluative Sciences, Weill Cornell Medical Center, New York
| | - Carla Boutin-Foster
- At the time of the study, Helen Cole was with the Division of Health Behavior, Department of Population Health, New York University School of Medicine, New York, NY. Hayley S. Thompson is with the Population Studies and Disparities Research Program, Communication and Behavioral Oncology, Karmanos Cancer Institute, Detroit, MI. Marilyn White and Ruth Browne are with the Arthur Ashe Institute for Urban Health, Brooklyn, NY. Chau Trinh-Shevrin, Scott Braithwaite, and Joseph Ravenell are with the Department of Population Health, New York University School of Medicine. Kevin Fiscella is with the Departments of Family Medicine and Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carla Boutin-Foster is with the Division of Clinical Epidemiology and Evaluative Sciences, Weill Cornell Medical Center, New York
| | - Joseph Ravenell
- At the time of the study, Helen Cole was with the Division of Health Behavior, Department of Population Health, New York University School of Medicine, New York, NY. Hayley S. Thompson is with the Population Studies and Disparities Research Program, Communication and Behavioral Oncology, Karmanos Cancer Institute, Detroit, MI. Marilyn White and Ruth Browne are with the Arthur Ashe Institute for Urban Health, Brooklyn, NY. Chau Trinh-Shevrin, Scott Braithwaite, and Joseph Ravenell are with the Department of Population Health, New York University School of Medicine. Kevin Fiscella is with the Departments of Family Medicine and Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carla Boutin-Foster is with the Division of Clinical Epidemiology and Evaluative Sciences, Weill Cornell Medical Center, New York
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Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Levin TR, Lieberman D, Robertson DJ. Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2017; 153:307-323. [PMID: 28600072 DOI: 10.1053/j.gastro.2017.05.013] [Citation(s) in RCA: 446] [Impact Index Per Article: 63.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This document updates the colorectal cancer (CRC) screening recommendations of the U.S. Multi-Society Task Force of Colorectal Cancer (MSTF), which represents the American College of Gastroenterology, the American Gastroenterological Association, and The American Society for Gastrointestinal Endoscopy. CRC screening tests are ranked in 3 tiers based on performance features, costs, and practical considerations. The first-tier tests are colonoscopy every 10 years and annual fecal immunochemical test (FIT). Colonoscopy and FIT are recommended as the cornerstones of screening regardless of how screening is offered. Thus, in a sequential approach based on colonoscopy offered first, FIT should be offered to patients who decline colonoscopy. Colonoscopy and FIT are recommended as tests of choice when multiple options are presented as alternatives. A risk-stratified approach is also appropriate, with FIT screening in populations with an estimated low prevalence of advanced neoplasia and colonoscopy screening in high prevalence populations. The second-tier tests include CT colonography every 5 years, the FIT-fecal DNA test every 3 years, and flexible sigmoidoscopy every 5 to 10 years. These tests are appropriate screening tests, but each has disadvantages relative to the tier 1 tests. Because of limited evidence and current obstacles to use, capsule colonoscopy every 5 years is a third-tier test. We suggest that the Septin9 serum assay (Epigenomics, Seattle, Wash) not be used for screening. Screening should begin at age 50 years in average-risk persons, except in African Americans in whom limited evidence supports screening at 45 years. CRC incidence is rising in persons under age 50, and thorough diagnostic evaluation of young persons with suspected colorectal bleeding is recommended. Discontinuation of screening should be considered when persons up to date with screening, who have prior negative screening (particularly colonoscopy), reach age 75 or have <10 years of life expectancy. Persons without prior screening should be considered for screening up to age 85, depending on age and comorbidities. Persons with a family history of CRC or a documented advanced adenoma in a first-degree relative age <60 years or 2 first-degree relatives with these findings at any age are recommended to undergo screening by colonoscopy every 5 years, beginning 10 years before the age at diagnosis of the youngest affected relative or age 40, whichever is earlier. Persons with a single first-degree relative diagnosed at ≥60 years with CRC or an advanced adenoma can be offered average-risk screening options beginning at age 40 years.
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Affiliation(s)
- Douglas K Rex
- Indiana University School of Medicine, Indianapolis, Indiana.
| | | | - Jason A Dominitz
- VA Puget Sound Health Care System, University of Washington, Seattle, Washington
| | | | | | - Tonya Kaltenbach
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | | | | | - Douglas J Robertson
- VA Medical Center, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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50
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Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Levin TR, Lieberman D, Robertson DJ. Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2017; 112:1016-1030. [PMID: 28555630 DOI: 10.1038/ajg.2017.174] [Citation(s) in RCA: 430] [Impact Index Per Article: 61.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This document updates the colorectal cancer (CRC) screening recommendations of the U.S. Multi-Society Task Force of Colorectal Cancer (MSTF), which represents the American College of Gastroenterology, the American Gastroenterological Association, and The American Society for Gastrointestinal Endoscopy. CRC screening tests are ranked in 3 tiers based on performance features, costs, and practical considerations. The first-tier tests are colonoscopy every 10 years and annual fecal immunochemical test (FIT). Colonoscopy and FIT are recommended as the cornerstones of screening regardless of how screening is offered. Thus, in a sequential approach based on colonoscopy offered first, FIT should be offered to patients who decline colonoscopy. Colonoscopy and FIT are recommended as tests of choice when multiple options are presented as alternatives. A risk-stratified approach is also appropriate, with FIT screening in populations with an estimated low prevalence of advanced neoplasia and colonoscopy screening in high prevalence populations. The second-tier tests include CT colonography every 5 years, the FIT-fecal DNA test every 3 years, and flexible sigmoidoscopy every 5 to 10 years. These tests are appropriate screening tests, but each has disadvantages relative to the tier 1 tests. Because of limited evidence and current obstacles to use, capsule colonoscopy every 5 years is a third-tier test. We suggest that the Septin9 serum assay (Epigenomics, Seattle, Wash) not be used for screening. Screening should begin at age 50 years in average-risk persons, except in African Americans in whom limited evidence supports screening at 45 years. CRC incidence is rising in persons under age 50, and thorough diagnostic evaluation of young persons with suspected colorectal bleeding is recommended. Discontinuation of screening should be considered when persons up to date with screening, who have prior negative screening (particularly colonoscopy), reach age 75 or have <10 years of life expectancy. Persons without prior screening should be considered for screening up to age 85, depending on age and comorbidities. Persons with a family history of CRC or a documented advanced adenoma in a first-degree relative age <60 years or 2 first-degree relatives with these findings at any age are recommended to undergo screening by colonoscopy every 5 years, beginning 10 years before the age at diagnosis of the youngest affected relative or age 40, whichever is earlier. Persons with a single first-degree relative diagnosed at ≥60 years with CRC or an advanced adenoma can be offered average-risk screening options beginning at age 40 years.
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Affiliation(s)
- Douglas K Rex
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Jason A Dominitz
- VA Puget Sound Health Care System, University of Washington, Seattle, Washington, USA
| | | | | | - Tonya Kaltenbach
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | | | | | - Douglas J Robertson
- VA Medical Center, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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