Researchers from the Roger Williams Medical Center in Providence, Rhode Island have shown that high rates of colorectal cancer screening can be achieved among Hispanic adults with the aid of a culturally tailored patient navigation program (CTPNP).
Use of the CTPNP may also help eliminate gender disparities in screening previously seen in these individuals, shows research published in Cancer.
Colorectal cancer is the second leading cause of cancer-related death in Hispanic patients, and although screening colonoscopy can reduce the incidence and mortality of colorectal cancer, its uptake has typically been low at around 40% to 55% among this group.
“The most significant barrier to care is insurance status,” said study lead Abdul Saied Calvino, Assistant Professor of Surgery at the Roger Williams Medical Center.
And although this problem has improved with the introduction of the Affordable Care Act in 2010, Dr. Saied Calvino told Inside Precision Medicine that “other patient-specific barriers to care persist, such as cultural and language barriers, low educational levels, and in the case of colorectal cancer screening, the time and preparation required for a quality screening colonoscopy.”
In order to overcome these barriers, Saied Calvino and team created a CTPNP and evaluated its efficacy in 698 Hispanic individuals (53% female and 47% male) aged 31 to 58 years (median 56 years) over a 28-month period.
“Tailored patient navigation allows patients to communicate with a healthcare proxy that speaks their language, understands their culture, and has the time to educate them about the benefits of cancer screening. A patient navigator can help patients overcome barriers to care, improve health education, ensure timely screening and patient engagement. They can also follow up on results of screening tests to make sure patients receive further needed testing or treatments,” said Saied Calvino.
For the current program, participants were sent an introductory letter in their native language followed by a by a phone call from a culturally competent, Spanish-speaking patient navigator who was hired specifically for the role and underwent 2 months of training prior to patient contact.
The patient navigator educated patients the importance of colorectal cancer screening and was also able to provide assistance with scheduling, transportation, arranging time off work, and ensuring adequate bowel preparation prior to colonoscopy.
The day before the patient’s scheduled colonoscopy, the patient navigator contacted the patient by phone again to confirm the appointment and transportation, address any new questions or concerns, and reiterate the importance of adhering to the bowel preparation regimen.
Saied Calvino and co-investigators report that following the intervention, 85% of study participants underwent colonoscopy, which is higher than the CDC target of 80%.
Furthermore, there was no difference in the rate between men and women, suggesting that “navigation and education can overcome the previously-reported gender gap in utilization,” Saied Calvino remarked.
The colonoscopy cancellation rate during the study was 9% and the no-show rate was 6%, which the researchers say was most commonly due to cost or an inability to contact the patient after referral.
Among the 592 individuals who underwent colonoscopy, 43% had polyps removed and 1.3% required a portion of their colon to be removed. Five (0.8%) patients were diagnosed with colorectal cancer.
Of note, a post procedure survey revealed that 90% of individuals who underwent colonoscopy said they would not have done so without the navigator’s assistance.
Saied Calvino believes that this was due, in part, to the fact that the navigator would meet the patient in person before the procedure. “After having multiple conversations by phone, they had the opportunity to meet the navigator and feel that there was someone there to assist them before the procedure and the day of the procedure. This was very important for the patients,” he said.
Following the success of the program, which was initially funded with a grant from the OLDCO Foundation, it will now receive continued support from the Roger Williams Medical Center.
“In the US patient navigators are not yet part of our routine workforce, and they are not supported in our system. Hopefully, with studies like ours, we can encourage other institutions to follow our steps,” said Saied Calvino
He added: “Future work to create health policies that support the use of tailored patient navigation needs to occur. It’s time for patient navigation to be part of our healthcare system, and yes, navigation should be tailored to other ethnic groups too.”
