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Rawl SM, Perkins SM, Tong Y, Katz ML, Carter-Bawa L, Imperiale TF, Schwartz PH, Fatima H, Krier C, Tharp K, Shedd-Steele R, Magnarella M, Malloy C, Haunert L, Gebregziabher N, Paskett ED, Champion V. Patient Navigation Plus Tailored Digital Video Disc Increases Colorectal Cancer Screening Among Low-Income and Minority Patients Who Did Not Attend a Scheduled Screening Colonoscopy: A Randomized Trial. Ann Behav Med 2024; 58:314-327. [PMID: 38470961 PMCID: PMC11008590 DOI: 10.1093/abm/kaae013] [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] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Up to 50% of people scheduled for screening colonoscopy do not complete this test and no studies have focused on minority and low-income populations. Interventions are needed to improve colorectal cancer (CRC) screening knowledge, reduce barriers, and provide alternative screening options. Patient navigation (PN) and tailored interventions increase CRC screening uptake, however there is limited information comparing their effectiveness or the effect of combining them. PURPOSE Compare the effectiveness of two interventions to increase CRC screening among minority and low-income individuals who did not attend their screening colonoscopy appointment-a mailed tailored digital video disc (DVD) alone versus the mailed DVD plus telephone-based PN compared to usual care. METHODS Patients (n = 371) aged 45-75 years at average risk for CRC who did not attend a screening colonoscopy appointment were enrolled and were randomized to: (i) a mailed tailored DVD; (ii) the mailed DVD plus phone-based PN; or (iii) usual care. CRC screening outcomes were from electronic medical records at 12 months. Multivariable logistic regression analyses were used to study intervention effects. RESULTS Participants randomized to tailored DVD plus PN were four times more likely to complete CRC screening compared to usual care and almost two and a half times more likely than those who were sent the DVD alone. CONCLUSIONS Combining telephone-based PN with a mailed, tailored DVD increased CRC screening among low-income and minority patients who did not attend their screening colonoscopy appointments and has potential for wide dissemination.
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Affiliation(s)
- Susan M Rawl
- Center for Research and Scholarship, School of Nursing, Indiana University at Indianapolis, Indianapolis, IN, USA
- Cancer Prevention and Control Program, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Susan M Perkins
- Cancer Prevention and Control Program, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Yan Tong
- Cancer Prevention and Control Program, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mira L Katz
- Department of Health Behavior and Health Promotion, College of Public Heath, The Ohio State University (OSU), Columbus, OH, USA
- Cancer Control Program, Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH, USA
| | - Lisa Carter-Bawa
- Community Outreach and Engagement, Center for Discovery & Innovation, Cancer Prevention Precision Control Institute, Hackensack Meridian Health, Nutley, NJ, USA
| | - Thomas F Imperiale
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Peter H Schwartz
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hala Fatima
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Connie Krier
- Center for Research and Scholarship, School of Nursing, Indiana University at Indianapolis, Indianapolis, IN, USA
| | - Kevin Tharp
- Indiana University Center for Survey Research, Bloomington, IN, USA
| | - Rivienne Shedd-Steele
- Cancer Prevention and Control Program, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | | | - Caeli Malloy
- Center for Research and Scholarship, School of Nursing, Indiana University at Indianapolis, Indianapolis, IN, USA
| | - Laura Haunert
- School of Health and Human Sciences, Physician Assistant Program, Indiana University at Indianapolis, Indianapolis, IN, USA
| | - Netsanet Gebregziabher
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Electra D Paskett
- Cancer Control Program, Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH, USA
- Division of Cancer Prevention and Control, Department of Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Victoria Champion
- Center for Research and Scholarship, School of Nursing, Indiana University at Indianapolis, Indianapolis, IN, USA
- Cancer Prevention and Control Program, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
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Chan RJ, Milch VE, Crawford-Williams F, Agbejule OA, Joseph R, Johal J, Dick N, Wallen MP, Ratcliffe J, Agarwal A, Nekhlyudov L, Tieu M, Al-Momani M, Turnbull S, Sathiaraj R, Keefe D, Hart NH. Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature. CA Cancer J Clin 2023; 73:565-589. [PMID: 37358040 DOI: 10.3322/caac.21788] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 06/27/2023] Open
Abstract
Patient navigation is a strategy for overcoming barriers to reduce disparities and to improve access and outcomes. The aim of this umbrella review was to identify, critically appraise, synthesize, and present the best available evidence to inform policy and planning regarding patient navigation across the cancer continuum. Systematic reviews examining navigation in cancer care were identified in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), Epistemonikos, and Prospective Register of Systematic Reviews (PROSPERO) databases and in the gray literature from January 1, 2012, to April 19, 2022. Data were screened, extracted, and appraised independently by two authors. The JBI Critical Appraisal Checklist for Systematic Review and Research Syntheses was used for quality appraisal. Emerging literature up to May 25, 2022, was also explored to capture primary research published beyond the coverage of included systematic reviews. Of the 2062 unique records identified, 61 systematic reviews were included. Fifty-four reviews were quantitative or mixed-methods reviews, reporting on the effectiveness of cancer patient navigation, including 12 reviews reporting costs or cost-effectiveness outcomes. Seven qualitative reviews explored navigation needs, barriers, and experiences. In addition, 53 primary studies published since 2021 were included. Patient navigation is effective in improving participation in cancer screening and reducing the time from screening to diagnosis and from diagnosis to treatment initiation. Emerging evidence suggests that patient navigation improves quality of life and patient satisfaction with care in the survivorship phase and reduces hospital readmission in the active treatment and survivorship care phases. Palliative care data were extremely limited. Economic evaluations from the United States suggest the potential cost-effectiveness of navigation in screening programs.
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Affiliation(s)
- Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Vivienne E Milch
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Cancer Australia, Sydney, New South Wales, Australia
- School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Fiona Crawford-Williams
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Oluwaseyifunmi Andi Agbejule
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Ria Joseph
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Jolyn Johal
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Narayanee Dick
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Matthew P Wallen
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, Victoria, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Anupriya Agarwal
- Cancer Australia, Sydney, New South Wales, Australia
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Larissa Nekhlyudov
- Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew Tieu
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | | | | | | | - Dorothy Keefe
- Cancer Australia, Sydney, New South Wales, Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Nicolas H Hart
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute for Health Research, The University of Notre Dame Australia, Perth, Western Australia, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
- Human Performance Research Centre, Innovative Solutions for Well-being and Health (INSIGHT) Research Institute, Faculty of Health, University of Technology Sydney (UTS), Sydney, New South Wales, Australia
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Dankner L, Quiros JA, Volpert D, Atreja A. Evaluating the use of a customized digital navigation program to optimize bowel preparation in pediatric colonsocopy. Front Pediatr 2023; 11:1271222. [PMID: 37876520 PMCID: PMC10591091 DOI: 10.3389/fped.2023.1271222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/06/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction Adequate bowel preparation is essential for optimal colonoscopy diagnosis and/or intervention. However, suboptimal bowel preparation occurs in as many as 1 in 3 pediatric colonoscopies, leading to missed diagnoses, procedural complications, wasted resources, and increased costs. We aimed to evaluate the effect of an automated Pediatric Colonoscopy Digital Navigation Program (PC-DNP) on the quality of colonoscopy preparation among pediatric patients. Methods The PC-DNP sent patients timely weight-based bowel preparation instructions, video and text-based educational modules, logistical information, and appointment reminders prior to their scheduled diagnostic and/or therapeutic colonoscopies. Physician reported bowel preparation quality among patients/caregivers who were prescribed the PC-DNP were compared to bowel preparation quality of a historical sample of patients/caregivers who received standard care instructions. Results We found that the PC-DNP group had significantly higher bowel preparation quality than the standard care group. Conclusions These results demonstrated that automated DNPs may be easily implemented into the pediatric gastroenterologists' practice and may help streamline and improve bowel preparation in pediatric patients.
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Affiliation(s)
- Lauren Dankner
- Division of Pediatric Gastroenterology, Valley Hospital, Ridgewood, NJ, United States
| | - Jose Antonio Quiros
- Division of Pediatric Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Diana Volpert
- Division of Pediatric Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ashish Atreja
- Chief Information and Digital Health Officer, UC Davis Medical Center, Sacramento, CA, United States
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Wonggom P, Rattanakanokchai S, Suebkinorn O. Effectiveness of bowel preparation innovative technology instructions (BPITIs) on clinical outcomes among patients undergoing colonoscopy: a systematic review and meta-analysis. Sci Rep 2023; 13:10783. [PMID: 37402823 DOI: 10.1038/s41598-023-37044-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/14/2023] [Indexed: 07/06/2023] Open
Abstract
To evaluate the effectiveness of bowel preparation innovative technology instructions (BPITIs) among patients undergoing colonoscopy. We searched PubMed, MEDLINE, CINAHL, CENTRAL, Scopus, Web of Science, LILACS, ClinicalTrials.gov, and Google Scholar for randomised controlled trials (RCTs) and cluster-RCTs from inception to February 28, 2022. The Cochrane risk of bias (RoB) tool and GRADE were used to assess RoB and certainty of evidence, respectively. Meta-analyses with random-effects model were used for analysis. This review included 47 RCTs (84 records). Seven BPITIs were found among included studies: (1) mobile apps, (2) VDO stream from personal devices, (3) VDO stream from a hospital device, (4) SMS re-education, (5) telephone re-education, (6) computer-based education, and (7) web-based education. The findings demonstrate that BPITIs have a slight impact on adherence to overall instructions (RR 1.20, 95% CI 1.13-1.28; moderate-certainty evidence), adequate bowel preparation (RR 1.10, 95% CI 1.07-1.13; low-certainty evidence), and quality of bowel preparation score (SMD 0.42, 95% CI 0.33-0.52; low-certainty evidence) compared to routine care. BPITIs may enhance the clinical outcomes. Due to the low-certainty evidence and heterogeneity of the included studies, the findings should be interpreted cautiously. Well-designed and reported RCTs are required to confirm the findings.PROSPERO registration number: CRD42021217846.
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Affiliation(s)
- Parichat Wonggom
- Department of Adult Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Siwanon Rattanakanokchai
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Orathai Suebkinorn
- Department of Adult Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, 40002, Thailand.
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A Novel Convolutional Neural Network Model as an Alternative Approach to Bowel Preparation Evaluation Before Colonoscopy in the COVID-19 Era: A Multicenter, Single-Blinded, Randomized Study. Am J Gastroenterol 2022; 117:1437-1443. [PMID: 35973166 DOI: 10.14309/ajg.0000000000001900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/28/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Adequate bowel preparation is key to a successful colonoscopy, which is necessary for detecting adenomas and preventing colorectal cancer. We developed an artificial intelligence (AI) platform using a convolutional neural network (CNN) model (AI-CNN model) to evaluate the quality of bowel preparation before colonoscopy. METHODS This was a colonoscopist-blinded, randomized study. Enrolled patients were randomized into an experimental group, in which our AI-CNN model was used to evaluate the quality of bowel preparation (AI-CNN group), or a control group, which performed self-evaluation per routine practice (control group). The primary outcome was the consistency (homogeneity) between the results of the 2 methods. The secondary outcomes included the quality of bowel preparation according to the Boston Bowel Preparation Scale (BBPS), polyp detection rate, and adenoma detection rate. RESULTS A total of 1,434 patients were enrolled (AI-CNN, n = 730; control, n = 704). No significant difference was observed between the evaluation results ("pass" or "not pass") of the groups in the adequacy of bowel preparation as represented by BBPS scores. The mean BBPS scores, polyp detection rate, and adenoma detection rate were similar between the groups. These results indicated that the AI-CNN model and routine practice were generally consistent in the evaluation of bowel preparation quality. However, the mean BBPS score of patients with "pass" results were significantly higher in the AI-CNN group than in the control group, indicating that the AI-CNN model may further improve the quality of bowel preparation in patients exhibiting adequate bowel preparation. DISCUSSION The novel AI-CNN model, which demonstrated comparable outcomes to the routine practice, may serve as an alternative approach for evaluating bowel preparation quality before colonoscopy.
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Reinforced education by short message service improves the quality of bowel preparation for colonoscopy. Int J Colorectal Dis 2022; 37:815-822. [PMID: 35192000 DOI: 10.1007/s00384-022-04114-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to evaluate the effect of reinforced education (RE) by short message service (SMS) on the bowel preparation quality of patients undergoing colonoscopy. METHODS Randomized controlled trials (RCTs), conducted on the effect of RE by SMS on bowel preparation for colonoscopy from inception to November 1, 2021, were queried from databases, including PubMed, Web of Science, the Cochrane Library, and EMBASE. After extracting the data, meta-analysis was conducted using Review Manager Software version 5.3. RESULTS A total of seven RCTs with 5889 patients were subjected to meta-analysis. The rate of adequate bowel preparation in the SMS group (81.7%) was significantly higher than that in the control group (75.7%) (RR: 1.10, 95% CI: 1.03-1.17, p < 0.01). Four studies suggested that RE by SMS significantly reduced the non-attendance rate of patients for scheduled colonoscopy (RR: 0.74, 95% CI: 0.56-0.99, p < 0.05). CONCLUSION RE by SMS for patients undergoing colonoscopy can significantly improve the quality of bowel preparation and decrease the non-attendance rate of patients for scheduled colonoscopy.
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