Evaluation of a patient navigation program to promote colorectal cancer screening in rural Georgia, USA

Honeycutt, Sally; Green, Rhonda; Ballard, Denise; Hermstad, April; Brueder, Alex; Haardörfer, Regine; Yam, Jennifer; Arriola, Kimberly Jacob

doi:10.1002/cncr.28033

Cited by 66 publications

(87 citation statements)

References 30 publications

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“…However, socioeconomic disparities in mPCa presentation did exist even among patients with Medicare or private insurance, albeit to a smaller degree than those seen between patients with different insurance coverage. In addition to providing more insurance coverage, patient navigation strategies to improve access to screening among low SES populations [24] or follow-up after positive cancer screen [25] have the potential to be cost-effective ways to reduce late stage cancer diagnoses.…”

Section: Discussionmentioning

confidence: 99%

The effect of socioeconomic status, race, and insurance type on newly diagnosed metastatic prostate cancer in the United States (2004–2013)

Weiner

Matulewicz

Tosoian

et al. 2018

Urologic Oncology: Seminars and Original Investigations

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Background Understanding the characteristics of men who initially present with metastatic prostate cancer (mPCa) can better enable directed improvement initiatives. The objective of this study was to assess the relationship between socioeconomic status (SES) and newly diagnosed mPCa. Materials Methods All men diagnosed with PCa in the National Cancer Data Base from 2004 to 2013 were identified. Characteristics of men presenting with and without metastatic disease were compared. A 4-level composite metric of SES was created using Census-based income and education data. Multivariable logistic regression was used to evaluate the association between SES, race/ethnicity, and insurance and the risk of presenting with mPCa at the time of diagnosis. Results Of 1,034,754 patients diagnosed with PCa, 4% had mPCa at initial presentation. Lower SES (first vs. fourth quartile; odds ratio [OR] = 1.39, 95% CI: 1.35-1.44), black and Hispanic race/ethnicity (vs. white; OR = 1.47, 95% CI: 1.43-1.51 and OR = 1.22, 95% CI: 1.17-1.28, respectively), and having Medicaid or no insurance (vs. Medicare or private; OR = 3.91, 95% CI: 3.78-4.05) were each independently associated with higher odds of presenting with mPCa after adjusting for all other covariates. Conclusions Lower SES, race/ethnicity, and having Medicaid or no insurance were each independently associated with higher odds of presenting with metastases at the time of PCa diagnosis. Our findings may partially explain current PCa outcomes disparities and inform future efforts to reduce disparities.

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Section: Discussionmentioning

confidence: 99%

The effect of socioeconomic status, race, and insurance type on newly diagnosed metastatic prostate cancer in the United States (2004–2013)

Weiner

Matulewicz

Tosoian

et al. 2018

Urologic Oncology: Seminars and Original Investigations

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“…16,18,22 For the three studies promoting FOBTs only, findings suggest that the effect on CRC screening prevalence was enhanced if navigators provided ongoing counseling to overcome screening barriers and taught patients how to complete the FOBT. 19–21 …”

Section: Resultsmentioning

confidence: 98%

“…The remaining four studies looked at comparing patient navigation with CRC education 19,20 and established clinic protocols alone. 21 Honeycutt et al 22 compared health centers with a patient navigation program to health centers without a program. One study 16 had a sample of 21, another 20 had a sample of 207, but the rest had larger samples, from 450–1,413 participants.…”

Section: Resultsmentioning

confidence: 99%

“…Three interventions promoted screening by colonoscopy, 16,18,22 and three focused on increasing screening by FOBT. 19–21 One intervention 17 promoted screening by either FOBT or screening colonoscopy.…”

Section: Resultsmentioning

confidence: 99%

“…These authors recommended that community health centers establish an up-to-date and reliable electronic medical records system. 15,21,22 Baker et al 21 recommended that community health centers work closely with their information technology departments to establish a system to maintain current patient information. Dietrich et al 15 echoed this recommendation, stating that a systematic approach to update and maintain patient information is necessary.…”

Section: Resultsmentioning

confidence: 99%

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

Domingo¹,

Braun²

2017

Journal of Health Care for the Poor and Underserved

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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.

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Differences in Breast and Colorectal Cancer Screening Adherence Among Women Residing in Urban and Rural Communities in the United States

et al. 2021

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IMPORTANCE Screening for breast and colorectal cancer has resulted in reductions in mortality; however, questions remain regarding how these interventions are being diffused to all segments of the population. If an intervention is less amenable to diffusion, it could be associated with disparities in mortality rates, especially in rural vs urban areas.OBJECTIVES To compare the prevalence of breast and colorectal cancer screening adherence and to identify factors associated with screening adherence among women residing in rural vs urban areas in the United States. DESIGN, SETTING, AND PARTICIPANTSThis population-based cross-sectional study of women aged 50 to 75 years in 11 states was conducted from 2017 to 2020. MAIN OUTCOMES AND MEASURES Adherence to cancer screening based on the US PreventativeServices Task Force guidelines. For breast cancer screening, women who had mammograms in the past 2 years were considered adherent. For colorectal cancer screening, women who had (1) a stool test in the past year, (2) a colonoscopy in the past 10 years, or (3) a sigmoidoscopy in the past 5 years were considered adherent. Rural status was coded using Rural Urban Continuum Codes, and other variables were assessed to identify factors associated with screening. RESULTSThe overall sample of 2897 women included 1090 (38.4%) rural residents; 2393 (83.5%) non-Hispanic White women; 263 (9.2%) non-Hispanic Black women; 68 (2.4%) Hispanic women; 1629 women (56.2%) aged 50 to 64 years; and 712 women (24.8%) with a high school education or less. Women residing in urban areas were significantly more likely to be adherent to colorectal cancer screening compared with women residing in rural areas (1429 [82%] vs 848 [78%]; P = .01), whereas the groups were equally likely to be adherent to breast cancer screening (1347 [81%] vs 830 [81%]; P = .78). Multivariable mixed-effects logistic regression analyses confirmed that rural residence was associated with lower odds of being adherent to colorectal cancer screening (odds ratio [OR], 0.81; 95% CI, 0.66-0.99, P = .047). Non-Hispanic Black race was associated with adherence to breast cancer screening guidelines (OR, 2.85; 95% CI, 1.78-4.56; P < .001) but not colorectal cancer screening guidelines. CONCLUSIONS AND RELEVANCEIn this cross-sectional study, women residing in rural areas were less likely to be adherent to colorectal cancer screening guidelines but were similarly adherent to breast cancer screening. This suggests that colorectal cancer screening, a more recent intervention, may not be as available in rural areas as breast cancer screening, ie, colorectal screening has lower amenability.

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Evaluation of a patient navigation program to promote colorectal cancer screening in rural Georgia, USA

Cited by 66 publications

References 30 publications

The effect of socioeconomic status, race, and insurance type on newly diagnosed metastatic prostate cancer in the United States (2004–2013)

The effect of socioeconomic status, race, and insurance type on newly diagnosed metastatic prostate cancer in the United States (2004–2013)

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

Differences in Breast and Colorectal Cancer Screening Adherence Among Women Residing in Urban and Rural Communities in the United States

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