Online Program

Randomized controlled trial of patient navigation for colorectal cancer screening and cancer-related risk, worry in Latino Medicare beneficiaries

Monday, November 4, 2013

Kimberly Enard, PhD, MBA, MSHA, Cancer Education & Career Development Program, University of Texas Health Science Center at Houston School of Public Health, Houston, TX
Lucinda Nevarez, PhD, School of Social Work, The University of Houston, Houston, TX
Shelly Hovick, PhD, Department of Behavioral Science and Center for Health Equity and Evaluation Research, The University of Texas MD Anderson Cancer Center, Houston, TX
Lovell Jones, PhD, Dorothy I. Height Center for Health Equity and Evaluation Research, UT MD Anderson Cancer Center, Houston, TX
Patient navigation (PN) guides individuals through and around barriers that impede access to appropriate prevention, early detection, diagnosis, treatment, survivorship and end-of-life care. However, more evidence is needed to understand the effectiveness of PN in addressing disparities in cancer outcomes. This study, conducted as part of CMS' multicenter Cancer Prevention and Treatment Demonstration project, aimed to measure the effect of individualized PN, compared to standard printed colorectal cancer (CRC) education materials, on CRC screening behaviors and cancer-related risk and worry among Latino Medicare fee-for-service beneficiaries in Houston, Texas. We recruited/randomly assigned participants who had no cancer diagnosis within 5+ years of the study to PN (n=1,044) or control group (n=1,040) groups. Screening behaviors (FOBT within 2 years; colonoscopy/sigmoidoscopy within 5 years) and cancer-related risk and worry were measured at baseline (T1) and upon completion of the study (T2). The majority of participants were Latino (99.4%); born outside of the U.S. (45.1%); primarily Spanish-speaking (50.0%); female (59.3%); educated at less than a high school level (60.0%); and living in households with incomes of less than $20,000 annually (57.0%). At T1 and T2, no differences in CRC screening were found between groups, controlling for relevant patient characteristics. Participants receiving PN had lower mean cancer-related risk and worry at baseline, but no differences were found at T2. Among a sample of Latino Medicare beneficiaries, PN had no differential effect on CRC screening behaviors. Secondary analyses, however, suggest that PN may help to address cancer-related risk and worry in this population.

Learning Areas:

Administer health education strategies, interventions and programs
Advocacy for health and health education
Chronic disease management and prevention
Implementation of health education strategies, interventions and programs
Social and behavioral sciences

Learning Objectives:
Describe the rationale/evidence for using patient navigation to address cancer health disparities Evaluate the effect of patient navigation, compared to printed education materials, on colorectal cancer screening behaviors and knowledge in a predominantly Latino, Medicare population

Keyword(s): Patient Education, Access and Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Visiting Postdoctoral Fellow in the Center for Health Equity and Evaluation Research at the UT MD Anderson Cancer Center. I have led a multicenter study examining pathways to effectively use patient navigation to address health disparities among vulnerable populations. I have nearly 10 years of experience in healthcare management, primarily developing/implementing communication and outreach initiatives targeted to diverse patient and physician populations. My educational credentials include a PhD, MBA and MSHA.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.