Use of a Patient Navigator to Increase Colorectal Cancer Screening in an Urban Neighborhood Health Clinic

Jandorf, Lina; Gutierrez, Yahaira; López, Jaime; Christie, Jennifer; Itzkowitz, Steven H.

doi:10.1093/jurban/jti046

Cited by 207 publications

(214 citation statements)

References 12 publications

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“…Most studies that examine preventive CRC screening do so aiming to find the problem -e.g., patient barriers, [25][26][27][28][29][30] physician barriers, [5][6][7]31,32] system barriers [14,23,24,33,34] -and implement targeted interventions that solely impact CRC screening. These approaches, while successful to varying degrees, may be limited in their usefulness in applied practice settings for a number of reasons.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, few studies examine the impact of involving other health care team members on CRC screening. [14] There is a growing literature that suggests that office characteristics such as office practice structure [15,16] and competing demands [17] are associated with cancer screening, [15,16] and several new models of primary care advocate the use of teams in the delivery of health care. [12,13] The purpose of this paper is to determine if the inclusion of office staff in general behavioral counseling activities has the added benefit of enhancing rates of colorectal cancer screening.…”

Section: Introductionmentioning

confidence: 99%

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The effects of teamwork and system support on colorectal cancer screening in primary care practices

Hudson

Ohman‐Strickland

Cunningham

et al. 2007

Cancer Detection and Prevention

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BACKGROUND-While cancer screening is generally increasing in the U.S., colorectal cancer (CRC) screening remains low. Most CRC screening interventions focus either on patients or individual clinicians without examining the office context in which CRC screening is implemented. This study examines whether primary care practices that involve staff in general forms of health education have higher CRC screening rates than practices that do not.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The effects of teamwork and system support on colorectal cancer screening in primary care practices

Hudson

Ohman‐Strickland

Cunningham

et al. 2007

Cancer Detection and Prevention

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“…25,26 RESULTS Figure 1 presents a PRISMA flow diagram demonstrating the systematic review process and the final 15 articles that were included in the narrative review. The 15 studies were subdivided according to type of cancer screening that was evaluated, including breast (combined with other cancers), [27][28][29][30][31] colorectal cancer, [32][33][34][35][36][37][38][39][40][41][42][43][44] and cervical cancer, [45][46][47] represented in Table 1. Fifteen non-English languages were evaluated in these studies.…”

Section: Quality Appraisalmentioning

confidence: 99%

“…Fifteen non-English languages were evaluated in these studies. Eight articles (53 %) were controlled trials; six of these were randomized 28,33,35,37,41,44 and the remaining two were not. 45,46 Seven (46 %) were cohort studies.…”

Section: Quality Appraisalmentioning

confidence: 99%

“…The spoken non-English language skills of the patient navigators were minimally reported in seven, as navigators were described as Bbilingual,^either noted to be originally from a country where the target language was spoken, or the navigator's ethnicity was used as an additional descriptor (i.e., Bbilingual Hispanic woman^). 27,31,35,37,39,41,43 None of the studies formally assessed the language skills of the patient navigators in English or the target language.…”

Section: Quality Appraisalmentioning

confidence: 99%

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Navigating Language Barriers: A Systematic Review of Patient Navigators’ Impact on Cancer Screening for Limited English Proficient Patients

et al. 2016

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OBJECTIVES:To systematically review the literature on the impact of patient navigators on cancer screening for limited English proficient (LEP) patients. DATA SOURCES: Electronic databases (PubMed, PsycINFO via OVID, Web of Science, Cochrane, EMBASE, and Scopus) through 8 May 2015. ELIGIBILITY CRITERIA: Articles in this review had: (1) a study population of LEP patients eligible for breast, cervical or colorectal cancer screenings, (2) a patient navigator intervention to provide services prior to or during cancer screening, (3) a comparison of the patient navigator intervention to either a control group or another intervention, and (4) language-specific outcomes related to the patient navigator intervention. STUDY APPRAISAL:We assessed the quality of the articles using the Downs and Black Scale. RESULTS: Fifteen studies met the inclusion criteria and evaluated the screening rates for breast, colorectal, and cervical cancer in 15 language populations. Fourteen studies resulted in improved screening rates for LEP patients between 7 and 60 %. There was great variability in the patient navigation interventions evaluated. Training received by navigators was not reported in nine of the studies and no studies assessed the language skills of the patient navigators in English or the target language. LIMITATIONS: This study is limited by the variability in study designs and limited reporting on patient navigator interventions, which reduces the ability to draw conclusions on the full effect of patient navigators. CONCLUSIONS: Overall, we found evidence that navigators improved screening rates for breast, cervical and colorectal cancer screening for LEP patients. Future studies should systematically collect data on the training curricula for navigators and assess their English and nonEnglish language skills in order to identify ways to reduce disparities for LEP patients.

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So Much to Do, So Little Time

Fiscella¹,

Epstein²

2008

Arch Intern Med

150

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There is much to do in primary care and little time to do it. Currently, primary care delivery is organized around visits, often 15 minutes or less, during which much is expected of clinicians. This includes establishing partnerships with patient and families; addressing acute and chronic biomedical and psychosocial problems; prevention, care coordination; and ensuring informed decision-making that respects patients' needs and preferences. Visit-based care discriminates against socially disadvantaged patients, who often require more time due to complex health care needs and the challenge of establishing partnerships and communicating across chasms of race, ethnicity, education, language, and culture. Rushed visits exacerbate disparities in health car due to competing demands, miscommunications and activation of unconscious physician stereotypes. Addressing health care disparities requires radical transformation in the structure and financing of primary care and the roles of the health care team members and patients. One such innovation, the patient-centered medical home, organizes care around patients' needs, not visits. Thus, face-to-face visits and physician-centered care are supplanted by team-based care that relies on multiple communication modalities, expanded health information technology, population management, culturally-sensitive outreach and follow-up, and coaching patients to assume more active roles in care. Implementation requires payment reform that allocates resources based on the true costs of providing high quality care to socially disadvantaged patients. Ensuring success will require physician leadership and training in new care models, transformation in primary care culture, and redesign of care around the needs of patients, particularly those needing care the most.There is so much to do in primary care and so little time to do it. During 15-minute visits, 1 physicians are expected to form partnerships with patients and families, address complex acute and chronic biomedical and psychosocial problems, provide preventive care, coordinate care with specialists, and ensure informed decision-making that respects patients' needs and preferences. While this is a challenging task in straightforward visits, it is nearly impossible when caring for socially disadvantaged patients with complex biomedical and psychosocial problems and multiple barriers to care. Consider the following scenario.Mrs S is a 52-year old female housekeeper with poorly controlled diabetes, hypertension and obesity who missed her last two visits due to job conflicts. She hasn't reached her annual

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Use of a Patient Navigator to Increase Colorectal Cancer Screening in an Urban Neighborhood Health Clinic

Abstract: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United

Cited by 207 publications

References 12 publications

The effects of teamwork and system support on colorectal cancer screening in primary care practices

The effects of teamwork and system support on colorectal cancer screening in primary care practices

Navigating Language Barriers: A Systematic Review of Patient Navigators’ Impact on Cancer Screening for Limited English Proficient Patients

So Much to Do, So Little Time

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