Twists and Turns of Colorectal Screening: The Role of the Patient Navigator

The Colorado Colorectal Screening Program (CCSP) is a state wide program to provide endoscopic screening to low-income, uninsured Coloradans ages 50 to 64. The coordinating center at the University of Colorado Cancer Center partners with the primary care, safety net practices to implement the Program; as these institutions largely serve as the medical home for the medically underserved. The safety net partners with screening /treatment providers throughout Colorado to provide care for patients. Program components include: endoscopic screening, follow-up and treatment, patient navigation, and public awareness. Screening navigation is a key element of the Program, as the procedure requires prior cleansing of the bowel and sedation during the procedure. The screening navigator's role is to specifically educate patients about the procedure and reduce barriers. Since inception in 2006 to December 2009, CCSP screened over 9400 individuals. Approximately 26% of those screened had types of polyps removed that have potential of becoming cancer and 1% were diagnosed with colorectal cancer. The decision to base the screening patient navigator directly within the patient's medical home has resulted in vast improvements in adherence to the medical guidelines for screening and quality of care. Prior to Program implementation, safety net clinics reported low screening compliance rates and ‘no show' rates as high as 70% for referrals to screening. CCSP evaluation data demonstrate a no show rate of 12% and an adequate exam rate of 96%, which is dependent on good bowel preparation and education, both indicative of the success of the screening navigation.