Increasing Colorectal Cancer Screening at an Urban FQHC Using iFOBT and Patient Navigation

Martin, Richard Lewis; Tully, Madelaine; Kos, Allison; Frazer, David; Williamson, Amy; Conlon, Amy; Enser, James J.; LoConte, Noelle K.

doi:10.1177/1524839917705127

Cited by 11 publications

(13 citation statements)

References 35 publications

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“…Several other initiatives have had relatively positive success rates in improving CRC screening using FIT,42–46 patient5 47 48 and physician education 49–51. Patient outreach by a navigator had a positive impact on FIT completion rates similar to previous studies 46 52–54. A decline in the FIT completion rate in the last few months in 2017 may be attributed to the lack of sufficient time allocated to the patient navigator due to shortage of staffing in the IMC.…”

Section: Discussionsupporting

confidence: 53%

Faecal immunochemical testing implementation to increase colorectal cancer screening in primary care

et al. 2018

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Colorectal cancer (CRC) is the second leading cause of cancer death in USA, and CRC screening remains suboptimal. The aim of this quality improvement was to increase CRC screening in the internal medicine clinic (IMC) patients, between the ages of 50–75 years, from a baseline rate of 50%–70% over 12 months with the introduction of faecal immunochemical test (FIT) testing. We used the Plan–Do–Study–Act (PDSA) method and performed a root cause analysis to identify barriers to acceptance of CRC screening. The quality improvement team created a driver diagram to identify and prioritise change ideas. We developed a process flow map to optimise opportunities to improve CRC screening. We performed eight PDSA cycles. The major components of interventions included: (1) leveraging health information technology; (2) optimising team work, (3) education to patient, physicians and IMC staff, (4) use of patient navigator for tracking FIT completion and (5) interactive workshops for the staff and physicians to learn motivational interview techniques. The outcome measure included CRC screening rates with either FIT or colonoscopy. The process measures included FIT order and completion rates. Data were analysed using a statistical process control and run charts. Four hundred and seven patients visiting the IMC were offered FIT, and 252 (62%) completed the test. Twenty-two (8.7%) of patients were FIT positive, 14 of those (63.6%) underwent a subsequent diagnostic colonoscopy. We achieved 75% CRC screening with FIT or colonoscopy within 12 months and exceeded our goal. Successful strategies included engaging the leadership, the front-line staff and a highly effective multidisciplinary team. For average-risk patients, FIT was the preferred method of screening. We were able to sustain a CRC screening rate of 75% during the 6-month postproject period. Sustainable annual FIT is required for successful CRC screening.

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Section: Discussionsupporting

confidence: 53%

Faecal immunochemical testing implementation to increase colorectal cancer screening in primary care

et al. 2018

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“…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 .…”

Section: Resultsmentioning

confidence: 99%

“…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 .…”

Section: Resultsmentioning

confidence: 99%

“…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,…”

Section: Screeningmentioning

confidence: 99%

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

Bernardo

Zhang

Hery

et al. 2019

Cancer

139

166

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Published studies regarding patient navigation (PN) and cancer were reviewed to assess quality, determine gaps, and identify avenues for future research. The PubMed and EMBASE databases were searched for studies investigating the efficacy and cost‐effectiveness of PN across the cancer continuum. Each included article was scored independently by 2 separate reviewers with the Quality Assessment Tool for Quantitative Studies. The current review identified 113 published articles that assessed PN and cancer care, between August 1, 2010, and February 1, 2018, 14 of which reported on the cost‐effectiveness of PN programs. Most publications focused on the effectiveness of PN in screening (50%) and diagnosis (27%) along the continuum of cancer care. Many described the effectiveness of PN for breast cancer (52%) or colorectal cancer outcomes (51%). Most studies reported favorable outcomes for PN programs, including increased uptake of and adherence to cancer screenings, timely diagnostic resolution and follow‐up, higher completion rates for cancer therapy, and higher rates of attending medical appointments. Cost‐effectiveness studies showed that PN programs yielded financial benefits. Quality assessment showed that 75 of the 113 included articles (65%) had 2 or more weak components. In conclusion, this review indicates numerous gaps within the PN and cancer literature where improvement is needed. For example, more research is needed at other points along the continuum of cancer care outside of screening and diagnosis. In addition, future research into the effectiveness of PN for understudied cancers outside of breast and colorectal cancer is necessary along with an assessment of cost‐effectiveness and more rigorous reporting of study designs and results in published articles.

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“…A patient navigator project for blacks located at a Milwaukee FQHC was recently able to demonstrate a twofold increase in screening completion in this population. 44 A similar project in South Carolina, which served a population that was 71% black, achieved a remarkable 85% screening colonoscopy completion rate. 14 However, neither study stratified results by sex.…”

Section: State and Local Levelmentioning

confidence: 99%

Colorectal Cancer Screening in Black Men: Recommendations for Best Practices

Kwaan

Jones‐Webb

2018

American Journal of Preventive Medicine

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Screening for colorectal cancer has been demonstrated to reduce colorectal cancer mortality. Blacks have a higher mortality from this malignancy, particularly men, yet screening rates in this population are often found to be lower than in whites. A modest literature demonstrates effective interventions that can increase screening rates in blacks; however, results are not consistent and ongoing work is required. Most work has not addressed specific barriers to screening in black men. Given the lack of studies on black men only, this study evaluated the state of research in the black population using a PubMed search. The authors provide commentary that proposes increased (1) state and local government support for collaborative programs with healthcare organizations, including patient navigation; (2) augmented community-organizing efforts to generate more attention to the need for colorectal cancer screening in the black community, with a focus on black men; and (3) federal research funding to promote investigation into new interventions and evaluation of existing ones. Specific recommendations for black men include lowering the screening age to 45 years, increasing access to health care, the use of patient navigators, and improved reporting and monitoring of colorectal cancer screening rates.

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Increasing Colorectal Cancer Screening at an Urban FQHC Using iFOBT and Patient Navigation

Abstract: Our academic-community partnership provided an effective, evidence based, and sustainable model for increasing colorectal cancer screening in a high risk, low resource community.

Cited by 11 publications

References 35 publications

Faecal immunochemical testing implementation to increase colorectal cancer screening in primary care

Faecal immunochemical testing implementation to increase colorectal cancer screening in primary care

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

Colorectal Cancer Screening in Black Men: Recommendations for Best Practices

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