Program May Boost Colorectal Screenings for Hispanic Adults and Reduce Gender Disparities

Culturally tailored patient navigation can improve underserved individuals’ health literacy, trust in the health care system, and use of cancer screening tools, study results show.

A culturally tailored patient navigation program can improve the rate of colorectal cancer screening among Hispanic adults and potentially help eliminate historical gender disparities in such screenings, according to results of a study published online in Cancer.

Colorectal cancer is the second-leading cause of cancer-related death in Hispanic adults. Although screening colonoscopies can reduce the incidence and mortality of colorectal cancer, screening rates are low in Hispanic individuals and other underserved populations.

To address this, investigators from the Roger Williams Medical Center in Rhode Island developed a program in which individuals first received an introductory letter in their native language, followed by a phone call from a culturally competent, Spanish-speaking patient navigator.

The patient navigator educated individuals about the importance of colorectal cancer screening, while identifying challenges for individuals and intervening to address them.

For example, some navigators helped patients with difficulties with interpretation services, scheduling, time off work, transportation, or completing bowel preparation before a colonoscopy.

The day prior to the individual’s scheduled colonoscopy, the patient navigator contacts the individual by phone to confirm their appointment and transportation, address any new concerns, and reiterate the importance of adhering to the bowel preparation regimen.Over a 28-month period, 698 individuals in Rhode Island who were primarily Spanish speakers were enrolled in the program. The colonoscopy completion rate was approximately 85%, with no difference between females and males.

This compares with the nationwide rate of 40% to 55% among Hispanic adults and a lower rate of screening among Hispanic men compared with women.

The colonoscopy cancellation rate was approximately 9%, and the no-show rate was 6%. The most common reasons for cancellation or no-shows were cost-related issues or an inability to contact the individual after referral.

Approximately 90% of individuals who completed a colonoscopy reported that they would not have done so without the patient navigation program.

“Culturally tailored patient navigation is a useful intervention to improve underserved populations’ health literacy, cancer screening utilization, and trust in our health care system,” Saied Calvino, MD, MPH, of the Roger Williams Medical Center, said in a statement. “Educating and supporting underserved populations to increase the utilization of cancer screening services can save lives and, in the long term, decrease health costs.”.

Additionally, investigators noted that additional attention needs to be paid to individuals who cancel colonoscopies or do not show up for the procedures and are not reachable vie email or phone.

“We need to find ways to improve our communication with patients of underserved populations and in some cases use other screening methods, such as stool-based screening, which is less invasive and less time-consuming for the patient,” Calvino said.

The American Cancer Society recommends that adults aged 45 years and older with an average risk of colorectal cancer undergo regular screening with either a high-sensitivity stool-based test or structural examination, depending on the individual’s preference and testing availability.

Reference

Program may boost colorectal cancer screening among Hispanic adults and reduce related gender disparities. EurekAlert. News release. February 7, 2022. Accessed February 7, 2022. https://www.eurekalert.org/news-releases/942205