Characteristics of Effective Colorectal Cancer Screening Navigation Programs in Federally Qualified Health Centers: A Systematic Review

Abstract

In the U.S., colorectal cancer (CRC) incidence and mortality have declined due to screening and improvements in early detection; however, racial/ethnic disparities in screening and mortality persist. Patient navigation has been shown to be effective in increasing CRC screening prevalence. This systematic review answered three questions about navigation in federally qualified community health centers (FQHCs): 1) Which navigation activities increased CRC screening prevalence? 2) What were the challenges to implementing these programs in FQHCs? 3) Which clinic protocols supported screening completion? Findings suggest that navigation services must be tailored to the specific screening test provided. Federally qualified community health centers report difficulty maintaining a current electronic medical records system and sustaining funding; they should establish excellent patient tracking systems (for follow-up and annual rescreening) and establish multiple protocols to facilitate screening completion. With the movement toward patient-centered care models, patient navigation will be integral to FQHCs and their clients.

Patient Navigation Models for Lung Cancer

“…10,11 One SR included patients with a wide range of cancer types (including lung cancer). 12 Patient navigation programs targeted vulnerable patient groups, including those who are low-income, 10 medically underserved, 11 part of racial/ethnic minority groups, 9,10 or older. 12 Table 2 provides additional detail on these reviews.…”

“…Patient navigation was delivered by both health care professionals [9][10][11][12] (including nurses 10,11 and social workers 11 ) and lay people. 10,11 The training provided to navigators was highly variable, with one SR 10 describing a range from a single six-hour training session to several hundred hours of programs.…”

“…Team-based interventions included pairing a lay person with a health care professional (such as a nurse or social worker) or pairing a nurse with an advanced practice nurse available to patients 24/7. 9 Primary Studies of the PNRP PNRP sites also described both individual and team-based navigator programs. The teambased interventions included pairing two lay people with two social workers.…”

“…Navigation programs were delivered across diverse settings, including community (churches and community-based organizations), 10 federally qualified health centers, 9 individual cancer centers, 12 primary care clinics, 10 and large medical centers. 10,12 Primary Studies of the PNRP The PNRP also delivered navigation in diverse settings including federally qualified health centers, 15 ambulatory care centers, 15 academic health systems, 14 and treatment units 18 (e.g., chemotherapy infusion units).…”

“…Navigators provided a range of services, including discussion and help overcoming barriers [9][10][11] (including transportation 9, 11 and translation [9][10][11] ), scheduling and coordinating appointments, 9,11 providing education and information on completing follow-up processes [9][10][11] (such as how to complete an at-home fecal occult blood test), as well as patient activation strategies 9,12 to promote patient engagement in care.…”