Patient navigation to increase colorectal cancer screening among Latino Medicare enrollees: a randomized controlled trial

Abstract

Purpose: Latino Medicare enrollees report suboptimal rates of colorectal cancer screening (CRCS) despite Medicare policies designed to improve CRCS access for older persons. Patient navigation (PN) may address many underlying barriers to CRCS, yet little is known about the effectiveness of PN to increase CRCS adherence among Latino Medicare enrollees.

Methods: Using a randomized controlled trial study design, we evaluated tailored PN delivered outside of primary care settings as an intervention to increase CRCS adherence in this population. Intervention participants (n = 135) received tailored PN services which included education, counseling, and logistical support administered in their language of choice. Comparison participants (n = 168) received mailed cancer education materials. We compared CRCS rates between interventions and used multivariable logistic regression to assess the odds of CRCS adherence for PN versus comparison groups after adjusting for covariates of interest.

Results: More navigated than non-navigated participants became CRCS adherent during the study period (43.7 vs. 32.1%, p = 0.04). The odds of CRCS adherence were significantly higher for PN relative to comparison participants before and after adjusting for covariates (unadjusted OR 1.64, p = 0.04; adjusted OR 1.82, p = 0.02). Higher CRCS adherence rates were observed primarily in the uptake of endoscopic screening methods.

Conclusion: This study demonstrates that PN delivered outside of the primary care environment is modestly effective in increasing CRCS adherence among Latino Medicare enrollees. This intervention strategy should be further evaluated as a complement to primary care-based PN and other care coordination strategies to increase adherence with CRCS and other evidence-based screenings among older Latinos.

Figure 1

Consolidated Standards of Reporting (CONSORT) Participant Flow Diagram Note: CRCS indicates colorectal cancer screening; FOBT, fecal occult blood test; COL/FS, colonoscopy or flexible sigmoidoscopy. *2 intervention and 2 control group participants were missing 6 month FOBT data.

FIGURE 2

Self-Reported Reasons for CRCS Nonadherence at Baseline, by Screening Method CRCS indicates colorectal cancer screening; FOBT, fecal occult blood test; COL/FS, colonoscopy or flexible sigmoidoscopy.