Interventions to Improve Care Related to Colorectal Cancer Among Racial and Ethnic Minorities: A Systematic Review

Abstract

ObjectiveTo systematically review the literature to identify interventions that improve minority health related to colorectal cancer care.Data sourcesMEDLINE, PsycINFO, CINAHL, and Cochrane databases, from 1950 to 2010.Study eligibility criteria, participants, and interventionsInterventions in US populations eligible for colorectal cancer screening, and composed of ≥50 % racial/ethnic minorities (or that included a specific sub-analysis by race/ethnicity). All included studies were linked to an identifiable healthcare source. The three authors independently reviewed the abstracts of all the articles and a final list was determined by consensus. All papers were independently reviewed and quality scores were calculated and assigned using the Downs and Black checklist.ResultsThirty-three studies were included in our final analysis. Patient education involving phone or in-person contact combined with navigation can lead to modest improvements, on the order of 15 percentage points, in colorectal cancer screening rates in minority populations. Provider-directed multi-modal interventions composed of education sessions and reminders, as well as pure educational interventions were found to be effective in raising colorectal cancer screening rates, also on the order of 10 to 15 percentage points. No relevant interventions focusing on post-screening follow up, treatment adherence and survivorship were identified.LimitationsThis review excluded any intervention studies that were not tied to an identifiable healthcare source. The minority populations in most studies reviewed were predominantly Hispanic and African American, limiting generalizability to other ethnic and minority populations.Conclusions and implications of key findingsTailored patient education combined with patient navigation services, and physician training in communicating with patients of low health literacy, can modestly improve adherence to CRC screening. The onus is now on researchers to continue to evaluate and refine these interventions and begin to expand them to the entire colon cancer care continuum.Electronic supplementary materialThe online version of this article (doi:10.1007/s11606-012-2044-2) contains supplementary material, which is available to authorized users.

Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial

“…Previous research supports the importance of provider recommendations for CRC screening, and patients who have never completed CRC screening may need provider counseling before completing a FIT. 30 , 33 , [37][38][39] Our study has several limitations. First, it was conducted in a single organization with a somewhat homogenous population and few clinical sites.…”

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

“…Previously defined categories from the literature were used to define the Downs and Black scores based on quality: 28-20: very good; 15-19: good; 11-14: fair; ≤10: poor). 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.…”

A Roadmap and Best Practices for Organizations to Reduce Racial and Ethnic Disparities in Health Care

“…Over the past seven years, Finding Answers has funded 33 research projects and performed 12 systematic literature reviews, including the five papers in this symposium. [2][3][4][5][6] We are now beginning to leverage this research base to provide technical assistance to organizations that are implementing disparities reduction interventions, such as those participating in RWJF's Aligning Forces for Quality program. 7 This paper summarizes the major lessons learned from the systematic reviews and provides a disparities reduction framework.…”