Knowledge of Polyp History and Recommended Follow-Up Among a Predominately African American Patient Population and the Impact of Patient Navigation

Fritz, Cassandra; Naylor, Keith; Kim, Karen

doi:10.1007/s40615-015-0152-5

Cited by 3 publications

(10 citation statements)

References 37 publications

(35 reference statements)

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“…Numerous studies indicate the importance of physician recommendation in influencing a patient’s CRC screening decision [ 40 – 53 ], and this factor is a primary predictor for patient adherence with screening guidelines [ 54 – 56 ]. Provider challenges for CRC screening include (1) asymptomatic patients believe that screening is unnecessary, especially when offered an invasive procedure, and (2) the different screening methods may cause confusion, which underscores the scientific ambiguity surrounding the decision [ 49 ].…”

Section: Methodsmentioning

confidence: 99%

Implementing a multilevel intervention to accelerate colorectal cancer screening and follow-up in federally qualified health centers using a stepped wedge design: a study protocol

et al. 2020

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Background Screening for colorectal cancer (CRC) not only detects disease early when treatment is more effective but also prevents cancer by finding and removing precancerous polyps. Because many of our nation’s most disadvantaged and vulnerable individuals obtain health care at federally qualified health centers, these centers play a significant role in increasing CRC screening among the most vulnerable populations. Furthermore, the full benefits of cancer screenings must include timely and appropriate follow-up of abnormal results. Thus, the purpose of this study is to implement a multilevel intervention to increase rates of CRC screening, follow-up, and referral-to-care in federally qualified health centers, as well as simultaneously to observe and to gather information on the implementation process to improve the adoption, implementation, and sustainment of the intervention. The multilevel intervention will target three different levels of influences: organization, provider, and individual. It will have multiple components, including provider and staff education, provider reminder, provider assessment and feedback, patient reminder, and patient navigation. Methods This study is a multilevel, three-phase, stepped wedge cluster randomized trial with four clusters of clinics from four different FQHC systems. In the first phase, there will be a 3-month waiting period during which no intervention components will be implemented. After the 3-month waiting period, we will randomize two clusters to cross from the control to the intervention and the remaining two clusters to follow 3 months later. All clusters will stay at the same phase for 9 months, followed by a 3-month transition period, and then cross over to the next phase. Discussion There is a pressing need to reduce disparities in CRC outcomes, especially among racial/ethnic minority populations and among populations who live in poverty. Single-level interventions are often insufficient to lead to sustainable changes. Multilevel interventions, which target two or more levels of changes, are needed to address multilevel contextual influences simultaneously. Multilevel interventions with multiple components will affect not only the desired outcomes but also each other. How to take advantage of multilevel interventions and how to implement such interventions and evaluate their effectiveness are the ultimate goals of this study. Trial registration This protocol is registered at clinicaltrials.gov (NCT04514341) on 14 August 2020.

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Section: Methodsmentioning

confidence: 99%

Implementing a multilevel intervention to accelerate colorectal cancer screening and follow-up in federally qualified health centers using a stepped wedge design: a study protocol

et al. 2020

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“…The UCMC PN program was modeled on the American Cancer Society and the New York City Department of Health and Mental Hygiene's Colonoscopy Patient Navigator Program. [15][16][17] PN training took place for a 2-month period before initiation of the PN program and focused on the following topics: CRC and CRC screening methods, the follow-up process after a positive fecal test, quality metrics, data management, navigator roles and responsibilities, common patient barriers, communication skills with health care providers and other health professionals, cultural competency, and local community resources. In addition, the navigator had the opportunity to rotate through the colonoscopy suite at the UCMC as part of the patient experience process.…”

Section: Patient Navigation Interventionmentioning

confidence: 99%

“…Between 2013 and 2014, the University of Chicago Medical Center (UCMC) participated in a State of Illinois PN program to enhance CRC screening among uninsured Illinois residents. This pilot project suggested that PN was effective in increasing CRC screening and resulted in improved quality indicators compared with non‐navigated patients . In 2015, the UCMC was funded as a Centers for Disease Control and Prevention Colorectal Cancer Control Program grantee, supporting the opportunity to implement an onsite UCMC, non‐nurse–facilitated PN program in August 2016.…”

Section: Introductionmentioning

confidence: 99%

“…This pilot project suggested that PN was effective in increasing CRC screening and resulted in improved quality indicators compared with non-navigated patients. 15,16 In 2015, the UCMC was funded as a Centers for Disease Control and Prevention Colorectal Cancer Control Program grantee, supporting the opportunity to implement an onsite UCMC, non-nurse-facilitated PN program in Cancer November 1, 2018 August 2016. Non-nurse PN could offer a less expensive approach to implementing navigation for the successful completion of CRC screening than a nurse-based navigation program.…”

Section: Introductionmentioning

confidence: 99%

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Economic assessment of patient navigation to colonoscopy‐based colorectal cancer screening in the real‐world setting at the University of Chicago Medical Center

Kim

Randal

Johnson

et al. 2018

Cancer

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BACKGROUND: This report details the cost effectiveness of a non-nurse patient navigation (PN) program that was implemented at the University of Chicago Medical Center to increase colonoscopy-based colorectal cancer (CRC) screening. METHODS: The authors investigated the impact of the PN intervention by collecting process measures. Individuals who received navigation were compared with a historic cohort of non-navigated patients. In addition, a previously validated data-collection instrument was tailored and used to collect all costs related to developing, implementing, and administering the program; and the incremental cost per patient successfully navigated (the cost of the intervention divided by the change in the number who complete screening) was calculated. RESULTS: The screening colonoscopy completion rate was 85.1% among those who were selected to receive PN compared with 74.3% when no navigation was implemented. With navigation, the proportion of no-shows was 8.2% compared with 15.4% of a historic cohort of non-navigated patients. Because the perceived risk of noncompletion was greater among those who received PN (previous no-show or cancellation, poor bowel preparation) than that in the historic cohort, a scenario analysis was performed. Assuming no-show rates between 0% and 50% and using a navigated rate of 85%, the total incremental program cost per patient successfully navigated ranged from $148 to $359, whereas the incremental intervention-only implementation cost ranged from $88 to $215. CONCLUSIONS: The current findings indicate that non-nurse PN can increase colonoscopy completion, and this can be achieved at a minimal incremental cost for an insured population at an urban academic medical center.

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“…To date, few studies have assessed the validity of self-reported colonoscopy findings (5)(6)(7)(8), and the studies are further limited by small, nonrepresentative patient populations and/or use of diverse measures of accuracy. To address these gaps, we used data from the Study of Colonoscopy Utilization (SCU), an ancillary study nested within the Prostate, Lung, Colorectal, and Ovarian Screening Trial (PLCO), to determine: (i) how accurately people self-report colonoscopy findings (i.e., whether any polyps or adenomas were discovered), and (ii) whether particular characteristics of the patient or their colonoscopy experience predict accuracy of self-reported colonoscopy findings.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Self-reported Colonic Polyps: Results from the Prostate, Lung, Colorectal, and Ovarian Screening Trial Study of Colonoscopy Utilization

Wiseman

Silver

Klabunde

et al. 2020

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Colonoscopy follow-up recommendations depend on the presence or absence of polyps, and if found, their number, size, and histology. Patients may be responsible for conveying results between primary and specialty care or providing medical information to family members; thus, accurate reporting is critical. This analysis assessed the accuracy of self-reported colonoscopy findings.Methods: 3,986 participants from the Study of Colonoscopy Utilization, an ancillary study nested within the Prostate, Lung, Colorectal, and Ovarian Screening Trial, were included. Self-reports of polyp and adenoma were compared to medical records, and measures of sensitivity and specificity were calculated. Correlates of accurate self-report of polyp were assessed using logistic regression and weighted to account for study sampling.Results: The sensitivity and specificity of self-reported polyp findings were 88% and 85%, respectively, and for adenoma 11% and 99%, respectively. Among participants with a polyp, older age was associated with lower likelihood while polyp severity and non-white race were associated with increased likelihood of accurate recall. Among participants without a polyp, having multiple colonoscopies was associated with lower likelihood while family history of colorectal cancer was associated with increased likelihood of accurate recall. Among both groups, longer time since colonoscopy was associated with lower likelihood of accurate recall.Conclusions: Participants recalled with reasonable accuracy whether they had a prior polyp; however, recall of histology, specifically adenoma, was much less accurate.Impact: Identification of strategies to increase accurate selfreport of colonic polyps are needed, particularly for patientprovider communications and patient reporting of results to family members.

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Knowledge of Polyp History and Recommended Follow-Up Among a Predominately African American Patient Population and the Impact of Patient Navigation

Abstract: In an AA population, post-colonoscopy polyp recall rates were similar to those described in white populations. Uninsured patients who completed PN were more likely than insured usual care patients to accurately report the presence of polyps on colonoscopy.

Cited by 3 publications

References 37 publications

Implementing a multilevel intervention to accelerate colorectal cancer screening and follow-up in federally qualified health centers using a stepped wedge design: a study protocol

Implementing a multilevel intervention to accelerate colorectal cancer screening and follow-up in federally qualified health centers using a stepped wedge design: a study protocol

Economic assessment of patient navigation to colonoscopy‐based colorectal cancer screening in the real‐world setting at the University of Chicago Medical Center

Accuracy of Self-reported Colonic Polyps: Results from the Prostate, Lung, Colorectal, and Ovarian Screening Trial Study of Colonoscopy Utilization

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