Does Decision Support by Phone Increase Colorectal Cancer Screening in Hispanic Patients? [Internet]

Excerpt

Background: The colorectal cancer (CRC) screening rate among Hispanics in the United States is low. There is a need for research to develop effective, evidence-based intervention methods that can increase CRC screening among eligible individuals in this population.

Objectives: We designed the current study to test the impact of a mailed standard intervention (SI; an educational brochure, an immunochemical stool blood test [SBT], instructions for scheduling a screening colonoscopy, and a reminder) vs the combination of a mailed standard intervention plus telephone decision support and navigation intervention (DSNI) on CRC screening adherence among Hispanic primary care patients. Additionally, the study aimed to assess DSNI vs SI effects on participant screening decision stage and on knowledge and perceptions related to screening.

Methods: Between October 2014 and March 2017 our research team identified Hispanic patients, aged 50 to 75 years who were not up to date with CRC screening, in 5 primary care practices that were part of the Lehigh Valley Health Network in southeastern Pennsylvania. The research team randomized, consented, and surveyed patients either to an SI group (n = 203) or a DSNI group (n = 197). We provided SI group materials to both study groups in English and Spanish. DSNI group participants also received a telephone call from a bilingual patient navigator who reviewed the screening materials, verified the participant's preferred CRC screening test, and assessed the individual's likelihood of completing his or her preferred test. Using this information, the patient navigator helped DSNI group participants develop and implement a test-specific screening plan. We administered a 6-month telephone survey and conducted a 12-month medical records review for all participants. We assessed the primary outcome—screening adherence at 12 months postrandomization—using multivariable logistic regression. We also performed multivariable analyses to assess intervention impact on readiness to screen, as measured by change in decision stage, and on knowledge and perceptions about screening at 6 months postrandomization.

Results: Overall CRC screening adherence was significantly and substantially higher in the DSNI group than in the SI group (78% vs 43%, respectively; adjusted odds ratio [OR], 4.83; 95% CI, 3.08-7.58; P < .001). Compared with the SI group, the DSNI group also displayed a higher SBT screening rate (57% vs 43%, respectively; OR, 4.20; 95% CI, 2.63-6.70; P < .001), a higher colonoscopy screening rate (20% vs 6%, respectively; OR, 8.79; 95% CI, 4.13-8.74; P < .001), and greater “forward” change in screening decision stage (79% vs 50%, respectively; OR, 4.91; CI, 2.55-9.47; P < .001). Participant knowledge and perceptions related to CRC screening did not differ significantly by study group (P = .862 and .880, respectively).

Conclusions: Among Hispanic primary care patients, the DSNI strategy achieved significantly greater positive effects on CRC screening adherence, decision stage, and test-specific screening adherence.

Limitations and subpopulation considerations: The generalizability of study findings may be limited, as we conducted the study with patients from 5 primary care practices in a single health system; participants in the study may differ from Hispanic primary care patients in other geographic regions and primary care patient populations. Moreover, the effectiveness of DSNI delivery might have been influenced by unique characteristics of the patient navigator.