Predicting Colonoscopy Completion Among African American and Latino/a Participants in a Patient Navigation Program

Abstract

Patient Navigation (PN) effectively increases screening colonoscopy (SC) rates, a key to reducing deaths from colorectal cancer (CRC). Ethnic minority populations have disproportionately low SC rates and high CRC mortality rates and, therefore, especially stand to benefit from PN. Adapting the Health Belief Model as an explanatory model, the current analysis examined predictors of SC rates in two randomized studies that used PN to increase SC among 411 African American and 461 Latino/a patients at a large urban medical center. Speaking Spanish but not English (OR 2.192; p<0.005), having a higher income (OR 1.218; p<0.005), and scoring higher on the Pros of Colonoscopy scale (OR 1.535; p=0.023) independently predicted colonoscopy completion. Health education and PN programs that increase awareness of the benefits of getting a colonoscopy may encourage colonoscopy completion. In the context of language-appropriate PN programs for African American and Latino/a individuals, those with lower incomes and English speakers may require additional education and counseling to support their decision-making around colonoscopy.

The efficacy and cost‐effectiveness of patient navigation programs across the cancer continuum: A systematic review

“…The majority of these studies tested the impact of PN on screening rates for colorectal (n = 32 [67%]), breast (n = 13 [27%]), or cervical cancer (n = 4 [8%]) . Thirty‐nine articles reported a significant favorable increase in cancer screening rates for PN intervention groups versus controls . Thirteen studies (27%) targeted African American, Latino, Korean American, Asian/Pacific Islander, and non–US‐born urban minority populations .…”

“…Thirty‐nine articles reported a significant favorable increase in cancer screening rates for PN intervention groups versus controls . Thirteen studies (27%) targeted African American, Latino, Korean American, Asian/Pacific Islander, and non–US‐born urban minority populations . Eight studies (17%) focused on low‐income, uninsured, medically underserved populations, patients from safety‐net health systems, or women residing in shelters .…”

“…10, Thirty-nine articles reported a significant favorable increase in cancer screening rates for PN intervention groups versus controls. 10,[32][33][34][35][37][38][39][41][42][43][44][45][47][48][49][50][51][52][53][54][55][56][58][59][60][61][62][64][65][66]69,[71][72][73][74][75][76]78 Thirteen studies (27%) targeted African American, Latino, Korean American, Asian/Pacific Islander, and non-US-born urban minority populations. 42,47,49,50,52,57,58,65,71,72,…”

Cost‐effectiveness of patient navigation to increase adherence with screening colonoscopy among minority individuals

“…18,19,21 First, we explored navigation for 1-time screening colonoscopy in a cohort of previously unscreened adults aged 50 years who had the race/ethnicity and age distributions observed in our recent navigation study. 27 This simulation was constructed to reflect real-world, 1-time navigation in a population of mixed race/ethnicity and age.…”

“…Tables; and Medicare payments (Supporting Table 1; see online supporting information). For the current analyses, we constructed a hypothetical cohort based on our recent navigation study, 27 which included 43% African Americans, 49% Hispanics, 4% whites, and 4% others. For the African American, Hispanic, and white subpopulations, we adjusted the agedependent prevalence of lesions at simulation entry and the transition probabilities from normal to small polyp or localized CRC by a common factor, as previously reported, 29 and calibrated these to reflect the agedependent CRC incidence in each subpopulation reported in the 1992 SEER data, before the implementation of widespread screening.…”