Using community engagement methods and navigators to increase colon cancer screening and improve patient preparation for screening

Nevada has lower colorectal cancer screening rates than other states and a higher burden of colon cancer morbidity and mortality. A theory-driven tailored intervention developed in partnership with the community used evidence-based practices to a) increase knowledge about colon cancer and screening, and b) to assist patients in completing screenings. During the 16 months of delivery, community health workers (screening patient navigators) matched on the community’s gender and race/ethnicity, and integrated into gastroenterology clinic settings met all program goals which included a) enrolling an ethnically diverse group of hard-to-reach clinic-referred and community outreach patients into the program (N=415) b) screening 229 of the 392 (58%) patients identified as needing screening and c) obtaining over 90% of patients reporting satisfaction with the program.  There were no differences by gender, age, or race/ethnicity among enrollees who obtained screening.  A random sample (N=216) of non-navigated patients matched on gender and age collected from the participating gastroenterology clinics revealed no differences between navigated and non-navigated patients on polyps detected.  Non-navigated males were significantly more likely than navigated males to have either poor or only fair bowel preparation quality, χ2(1)=5.48, p<.05.  There was no difference between females.  Low-quality bowel preparation is a concern for gastroenterologists as it leads to incomplete readings of the colon or requires cancelling a colonoscopy.  This intervention shows that evidence-based screening patient navigator programs developed with the community and integrated with health care clinics are effective in a) increasing screenings among hard-to-reach and minority populations and b) improving bowel preparation quality for males.