Decision support and navigation to determine the likelihood of colorectal cancer screening among Hispanics

Hispanics have significantly lower colorectal cancer (CRC) screening rates and are more likely to be diagnosed with late-stage CRC than other racial or ethnic groups. Novel interventions are needed to promote screening adherence among Hispanic patients.

Hispanic primary care patients were randomized (n=103) to receive, a mailed standard intervention (SI) or a mailing plus telephone decision support and navigation intervention (DSNI). At enrollment, CRC screening test (stool blood test (SBT) or colonoscopy) preference was assessed for all participants. During the DSNI call, a bilingual patient assistant reviewed an educational pamphlet, used an online decision support tool to identify factors affecting the likelihood of screening and determined the patient’s likelihood of adherence. Likelihood of adherence was measured from 0.0 (overwhelmingly unlikely) to 1.0 (overwhelmingly likely).

Thus far, 22 DSNI participants have completed the intervention. Participants were mainly female (64%), under the age of 60 (64%), and Spanish speakers (86%). At baseline, most participants had an equal preference for SBT and colonoscopy (73%). After educational pamphlet review, 45% preferred SBT, while 55% preferred colonoscopy.  Participants had an average screening likelihood score of 0.77.  Among those who preferred SBT screening, the desire for knowledge about personal health, followed by favorable test characteristics influenced the likelihood of performance. For those who preferred colonoscopy, desire for knowledge, followed by worries and concerns about cancer affected likelihood of performance.

Patient education and decision support helped participants clarify their preferred screening test. Reported likelihood of screening performance was influenced by desire for health knowledge and other factors.