Promoting colonoscopy screening among low‐income Latinos at average risk of colorectal cancer: A randomized clinical trial

Abstract

BACKGROUND: Screening colonoscopy (SC) for colorectal cancer (CRC) is underused by Latino individuals. The current randomized clinical trial examined the impact of 3 interventions: 1) patient navigation; 2) patient navigation plus standard Centers for Disease Control and Prevention print materials; and 3) patient navigation plus culturally targeted print materials for Latinos referred for SC. Demographic, personal and health history, and psychometric factors associated with SC also were examined. METHODS: A total of 344 urban Latino individuals aged 50 to 85 years with no personal and/or immediate family history of CRC diagnosed before age 60 years, no personal history of a gastrointestinal disorder, no colonoscopy within the past 5 years, with insurance coverage, and with a referral for SC were consented. Participants were randomized to patient navigation (20%), patient navigation plus standard Centers for Disease Control and Prevention print materials (40%), and patient navigation plus culturally targeted print materials (40%). The completion of SC was assessed at 12 months. RESULTS: The interventions had an overall SC rate of 82%. Counterintuitively, patients with an average income of <$10,000 were found to have higher SC rates (87%) than those with a greater income (75%). CONCLUSIONS: The addition of standard or culturally targeted print materials did not appear to increase SC rates above those for patient navigation. Indeed, after controlling for other variables, culturally targeted print materials were found to be associated with lower SC rates among Puerto Rican individuals. Cancer 2020;126:782-791.

Effect of Behavioral Interventions on the Uptake of Colonoscopy for Colorectal Cancer Screening: A Systematic Review and Meta-Analysis

“…Patient navigation has improved CRC screening in several contexts, such as stool testing and follow-up after abnormal stool tests (19), minority groups with language barriers (23,24), groups with mental illness (32), and low-income and underinsured populations (31,39). In the 11 interventions that investigated patient navigation alone, we observed substantial heterogeneity for both the backgrounds of the navigators and the format of the navigation.…”

“…Twenty-one studies were randomized controlled trials and 6 were population-based (13)(14)(15)(16)(17)(18). Several studies focused on specific populations: 6 involved lowincome or racial minority groups in the United States (19)(20)(21)(22)(23)(24), 3 examined individuals with first-degree relatives with CRC (17,18,25), and 1 studied persons with human immunodeficiency virus (26). Six studies included patients younger than 50 years (15,17,18,22,25,27).…”

“…Six studies included patients younger than 50 years (15,17,18,22,25,27). For behavioral interventions, 3 interventions used mailed letters (13,16,28), 3 used informational brochures (24,29), 11 studied patient navigation (17)(18)(19)(20)(21)23,25,(30)(31)(32), 1 examined preprocedural telephone consultations ( 14), 1 studied PCP counseling (33), 2 used videos (22,26), 1 changed EHR settings (10), 1 used an email intervention (34), and 1 used a financial incentive (35). Six interventions studied the effects of multiple concurrent interventions (15,27,28,34,36).…”

“…In sensitivity analyses, we examined the effect of excluding trials that focused on specific populations. When excluding studies that involved low-income or racial minority groups in the United States (19)(20)(21)(22)(23)(24), the effect of overall interventions (OR 1.71, 95% CI 1.35-2.18) and patient navigation (OR 2.38, 95% CI 1.90-2.98) increased and the effect of informational brochures (OR 1.68, 95% CI 1.25-2.26) and videos (OR 5.28, 95% CI 1.20-23.32) both became significant. Without individuals who had first-degree relatives with CRC (17,18,25), the effect of overall interventions (OR 1.48, 95% CI 1.20-1.83) and patient navigation (OR 1.62, 95% CI 1.14-2.30) both decreased.…”

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

“…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).…”