Decision Support and Navigation to Increase Colorectal Cancer Screening Among Hispanic Patients

Myers, Ronald E.; Stello, Brian; Daskalakis, Constantine; Sifri, Randa; González, Evelyn; DiCarlo, Melissa; Johnson, Melanie; Hegarty, Sarah; Shaak, Kyle; Rivera, Alicia; Gordils-Molina, Lucas; Petrich, Anett; Careyva, Beth; de-Ortiz, Rosa; Diaz, Liselly

doi:10.1158/1055-9965.epi-18-0260

Cited by 23 publications

(12 citation statements)

References 32 publications

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“…Despite US Preventive Services Task Force recommendations for lung cancer screening, fewer than 5% of eligible individuals are screened, a low rate that has yet to be affected by Medicaid expansion, highlighting the need for more work . The Patient-Centered Outcomes Research Institute funds comparative effectiveness research with a recent focus on care delivery, including strategies to improve uptake of lung and colorectal cancer screening …”

Section: How Expansion Altered Medicaidmentioning

confidence: 99%

Understanding the Implications of Medicaid Expansion for Cancer Care in the US

et al. 2022

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Insurance status has been linked to important differences in cancer treatment and outcomes in the US. With more than 15 million individuals gaining health insurance through Medicaid expansion, there is an increasing need to understand the implications of this policy within the US cancer population. This review provides an overview of the fundamental principles and nuances of Medicaid expansion, as well as the implications for cancer care.OBSERVATIONS The Patient Protection and Affordable Care Act presented states with an option to expand Medicaid coverage by broadening the eligibility criteria (eg, raising the eligible income level). During the past 10 years, Medicaid expansion has been credited with a 30% reduction in the population of uninsured individuals in the US. Such a significant change in the insurance profile could have important implications for the 1.7 million patients diagnosed with cancer each year, the oncology teams that care for them, and policy makers. However, several factors may complicate efforts to characterize the effect of Medicaid expansion on the US cancer population. Most notably, there is considerable variation among states in terms of whether Medicaid expansion took place, when expansion occurred, eligibility criteria for Medicaid, and coverage types that Medicaid provides. In addition, economic and health policy factors may be intertwined with factors associated with Medicaid expansion. Finally, variability in the manner in which cancer care has been captured and depicted in large databases could affect the interpretation of findings associated with expansion. CONCLUSIONS AND RELEVANCEThe expansion of Medicaid was a historic public policy initiative. To fully leverage this policy to improve oncological care and to maximize learning for subsequent policies, it is critical to understand the effect of Medicaid expansion. This review aims to better prepare investigators and their audiences to fully understand the implications of this important health policy initiative.

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Section: How Expansion Altered Medicaidmentioning

confidence: 99%

Understanding the Implications of Medicaid Expansion for Cancer Care in the US

et al. 2022

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“…One multi-component intervention, including patient navigation for Latinas, reported nearly a 15-fold increase in cervical cancer screening completion (Shokar et al, 2021). Non–USA-born Latinos randomized to three interventions with a patient navigation component had a two-fold increase in successful completion of colorectal cancer screening (DuHamel et al, 2020), and those randomized to a decision-aid combined with patient navigation were nearly five times more likely to complete colorectal cancer screening (Myers et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial to Increase Cancer Screening and Reduce Depression Among Low-Income Women

Weiss

Cassells

Lin

et al. 2022

Journal of Prevention and Health Promotion

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Low-income women of color receive fewer cancer screenings and have higher rates of depression, which can interfere with cancer screening participation. This study assessed the comparative effectiveness of two interventions for improving colorectal, breast, and cervical cancer screening participation and reducing depression among underserved women in Bronx, NY, with depression. This comparative effectiveness randomized controlled trial (RCT) with assessments at study entry, 6, and 12 months utilized an intent-to-treat statistical approach. Eligible women were aged 50 to 64, screened positive for depression, and were overdue for ≥ 1 cancer screening (colorectal, breast, and/or cervical). Participants were randomized to a collaborative depression care plus cancer screening intervention (CCI + PCM) or cancer screening intervention alone (PCM). Interventions were telephone-based, available in English or Spanish, delivered over 12 months, and facilitated by a skilled care manager. Cancer screening data were extracted from electronic health records. Depression was measured with a validated self-report instrument (PHQ-9). Seven hundred fifty seven women consented and were randomized (CCI + PCM, n = 378; PCM, n = 379). Analyses revealed statistically significant increases in up-to-date status for all three cancer screenings; depression improved in both intervention groups. There were no statistically significant differences between the interventions in improving cancer screening rates or reducing depression. CCI and PCM both improved breast, cervical, and colorectal cancer screening and depression in clinical settings in underserved communities; however, neither intervention showed an advantage in outcomes. Decisions about which approach to implement may depend on the nature of the practice and alignment of the interventions with other ongoing priorities and resources.

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“…In a study of 400 Latinx patients overdue for CRC screening (Myers et al, 2019), participants were randomly assigned to one of two treatment conditions: (a) standard treatment or (b) decision support and navigation intervention. To gain insight into the application of the framework, we will discuss the study procedures in more detail.…”

Section: Informed Decision-makingmentioning

confidence: 99%

Colorectal cancer screening in Uruguay: current assessment and roadmap for the future

Reich

Buki

2021

Psicol. Refl. Crít.

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Cancer is a leading cause of death worldwide and is expected to remain a public health concern for years to come. Within Latin America, Uruguay has the highest colorectal cancer rates. Heeding past calls to action, in this article we provide a critical assessment of colorectal cancer needs and opportunities in Uruguay with a focus on developing a roadmap for future action. First, we provide an overview of risk factors, screening procedures and guidelines, and screening rates. Next, we provide an overview of psychosocial factors that influence colorectal cancer screening, with the goal of providing guidance for future behavioral health promotion initiatives in Uruguay. In this effort, we present four conceptual models that may be used for interventions: the ecological systems theory, informed decision-making, the health beliefs model, and the health literacy model. Subsequently, we propose using an integrated model based on the ecological systems theory and health literacy model to develop national, local, and community-based interventions to increase screening rates and lower the colorectal cancer burden in Uruguay. We close the paper with a summary and implications section, including recommendations for future research programs focused on the assessment of factors that influence screening.

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Decision Support and Navigation to Increase Colorectal Cancer Screening Among Hispanic Patients

Cited by 23 publications

References 32 publications

Understanding the Implications of Medicaid Expansion for Cancer Care in the US

Understanding the Implications of Medicaid Expansion for Cancer Care in the US

A Randomized Controlled Trial to Increase Cancer Screening and Reduce Depression Among Low-Income Women

Colorectal cancer screening in Uruguay: current assessment and roadmap for the future

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