Effects of a Community-to-Clinic Navigation Intervention on Colorectal Cancer Screening Among Underserved People

Menon, Usha; Szalacha, Laura A.; Kue, Jennifer; Herman, Patricia M.; Bucho-Gonzalez, Julie; Lance, Peter; Larkey, Linda

doi:10.1093/abm/kaz049

Cited by 15 publications

(21 citation statements)

References 16 publications

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“…30 A recent study has shown that education plus tailored navigation (in person or via phone) addressing individual barriers to screening are the most important components of any educational program aiming to increase adherence to CRC screening. 31 This retrospective study has several limitations. The NCDB is not population-based registry, but rather identifies patients from 1500 commission-accredited cancer programs, and potentially limits the generalizability of our patient population.…”

Section: Discussionmentioning

confidence: 98%

Health care disparities in colorectal and esophageal cancer

Schlottmann

Gaber

Strassle

et al. 2020

The American Journal of Surgery

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Background: We aimed to identify differences in disparities among patients with a cancer in which screening is widely recommended (colorectal cancer [CRC]) and one in which it is not (esophageal cancer). Methods: A retrospective analysis was performed using 2004e2015 data from the National Cancer Database. Multivariable generalized logistic regression was used to identify potential differences in the effect of disparities in stage at diagnosis. Results: A total of 96,524 esophageal cancer patients and 361,187 CRC patients were included. Black patients, longer travel distances, and lower educational attainment were only associated with increased odds of stage IV CRC. While both Medicaid and uninsured patients were more likely to be diagnosed with stage IV esophageal and CRC, the effect was larger among CRC patients. From 2004 to 2015, the rates of stage IV esophageal cancer decreased from 42.0% to 38.2%, while the rates of stage IV CRC increased from 36.9% to 40.8% (p < 0.0001). Conclusions: Disparities are more pronounced in CRC, compared to esophageal cancer. Equity in access to screening and cancer care should be prioritized.

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Section: Discussionmentioning

confidence: 98%

Health care disparities in colorectal and esophageal cancer

Schlottmann

Gaber

Strassle

et al. 2020

The American Journal of Surgery

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“…The adaptation of the intervention was guided by frameworks established by Card et al [37] albeit with modification. Because we were leveraging an existing intervention, [31][32][33] we did not seek out other materials. Our original intervention was adapted in the five recommended areas: language (words, literacy, cultural references in the message library [TIMS © ] and the training materials); updating research-based information (CRC and screening impact on AIs), images and exemplars for cultural relevance; updating staff training (all navigator training materials); and evaluation materials (REDCap database entry, navigator logs, EHR verifications).…”

Section: Intervention Adaptation Frameworkmentioning

confidence: 99%

“…We developed and tested this tailored navigator intervention (TIMS © ) in a randomized controlled trial design in a mixed African American and older non-Hispanic white population [33]. In a subsequent validating randomized controlled trial using TIMS © , conducted in an urban, underserved, largely Hispanic population, completion of CRC screening was increased almost fourfold in individuals receiving the tailored navigation intervention compared to the control [31].…”

Section: The Tailored Intervention Messaging System © (Tims © )mentioning

confidence: 99%

“…We report here the methods and results of adapting a navigation-based intervention and the early outcomes of the intervention on AI CRC screening disparities in an environment, as described, that hampers strategies found to be effective in the larger US population. A tailored navigation intervention that was developed and tested previously by our group [31][32][33] was adapted for AIs. The TIDieR (Template for Intervention Description and Replication) guide and checklist were used to describe the adapted intervention in sufficient detail (see Additional file 1) [34].…”

Section: Introductionmentioning

confidence: 99%

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Adaptation of colorectal cancer screening tailored navigation content for American Indian communities and early results using the intervention

Menon

Lance

Szalacha

et al. 2022

Implement Sci Commun

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Background American Indians (AI) experience major colorectal cancer (CRC) screening disparities with commensurate inequity in CRC mortality and other outcomes. The purpose of this report is to describe the methods and early results of adapting a previously successful intervention for the AI community. Methods The educational content and delivery strategy of the parent intervention were adapted for AIs guided by an adaptation framework and cultural consultations with the community and clinicians. As part of the environmental scanning, we identified the need to substantively revise our data entry, collection, and tracking system and develop a REDCap database for this purpose. In this study, we staggered the implementation of the intervention in each facility to inform the process from one clinic to the next, and assess both the clinical outcomes of the tailored intervention and the implementation processes across two clinic settings, Facilities A and B. Results The REDCap database is an indispensable asset, and without it we would not have been able to obtain reliable aggregate screening data while improvements to facility electronic health records are in progress. Approximately 8% (n = 678) of screening-eligible patients have been exposed to the navigator intervention. Of those exposed to the navigator intervention, 37% completed screening. Conclusions With the small numbers of patients exposed so far to the intervention, it would be premature to draw any broad conclusions yet about intervention effects. However, early screening completion rates are substantial advances on existing rates, and we have demonstrated that a tailored navigator intervention for facilitating CRC screening was readily adapted with provider and community input for application to AIs. A REDCap database for tracking of CRC screening by navigators using tablets or laptops on- or offline is easy to use and allows for generation of aggregate, anonymized screening data. Trial registration. There was no health intervention meeting the criteria of a clinical trial. The University of Arizona Institutional Review Board granted exemption from obtaining informed consent from patients undergoing CRC screening after administration of the tailored navigation intervention as usual care.

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“…Adopting methods from prior successful tailored messaging research (Lee et al, 2014; Lee-Lin et al, 2015; Menon et al, 2011) and clinic-based promotion of CRC screening (Larkey, Wilson, & Sillanpaa, 2009, 2015; Lee et al, 2014; Lee-Lin et al, 2015; Menon et al, 2011, 2020), a dissemination study was designed and funded by the National Cancer Institute (2012–2017) to demonstrate the use of the tailored messaging approach to navigate individuals from the community to clinics to receive CRC screening. From the time the proposal was conceived and written with community and clinic partners indicating support through letters of commitment to the time of funding and start-up, several communities, demographic, and healthcare policy conditions had changed, presenting challenges to study recruitment and implementation.…”

mentioning

confidence: 99%

Recruitment Challenges of a Colorectal Cancer Screening Dissemination Study

Larkey¹,

Szalacha²,

Bucho-Gonzalez³

et al. 2022

Nursing Research

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Background: Dissemination strategies to reach underserved and minority populations to promote screening for colorectal cancer (CRC) are key to reducing disparities. We conducted a study to examine a tailored messaging approach to navigate individuals from communities (i.e., lower income, less access to care, and underscreened) to clinics to receive CRC screening. We encountered several political, demographic, and secular trend issues that required reconsideration and redesign of implementation strategies.Objectives: Through study implementation from 2012 to 2017, changes in medical reimbursement and immigration policiesat the state level and later at the national level-affected healthcare delivery systems that had initially committed to supporting the study and our recruitment methods. Although our selected zip codes and sites had previously yielded high rates of CRC screening nonadherence, within a few years, these sites showed substantially higher screening adherence rates-yielding limited numbers of eligible participants. In addition, state immigration policy trends created mistrust and fear, leading to lower participation rates than anticipated. This report documents and provides valuable insights on how we and the community network developed creative strategies to overcome these challenges.Methods: New relationships with community partners were extended to tap advisory board input to meet the challenges. Criteria for clinic participation widened from originally selected Federally Qualified Health Centers (FQHCs) to various nonprofit, hybrid, and privately insured reimbursement types. Recruitment site options were creatively redefined to reach community participants where they live, work, and receive services.Results: Strategies that engage community members in identifying alternative healthcare delivery structures and that link recruitment efforts to community-based service organizations were found to be critical to recapturing community trust in the face of unfavorable political environments. Widening the type of clinic partners from FQHCs to stand-alone nonprofits and private clinics and identifying unusual types of recruitment sites provided alternative solutions for successful study implementation.Discussion: In prevention-based studies that face unplanned system and political barriers to recruitment, embedding the study in the community may aid in reestablishing trust levels to improve engagement and recruitment of clinic partners and eligible participants.

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Effects of a Community-to-Clinic Navigation Intervention on Colorectal Cancer Screening Among Underserved People

Cited by 15 publications

References 16 publications

Health care disparities in colorectal and esophageal cancer

Health care disparities in colorectal and esophageal cancer

Adaptation of colorectal cancer screening tailored navigation content for American Indian communities and early results using the intervention

Recruitment Challenges of a Colorectal Cancer Screening Dissemination Study

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