According to the Centers for Disease Control and Prevention, one in three adults between 50 and 75 years doesn't undergo colorectal cancer screening, and the problem is even worse among foreign-born residents, racial minorities, and certain other groups. The use of laypeople from the community as "navigators" to educate patients and guide them through the health care system is one way to address barriers to screening, a new study suggests.

Figure. Mary Paul (center), a patient navigator for the Texas Tech University Health Sciences' Larry Combest Community Health and Wellness Center, provides chronic disease case management navigation for one of the center's patients in the patient's home. Photo courtesy of the Texas Tech University Health Sciences School of Nursing.

Among patients treated at urban community health centers or public hospital-based clinics, 465 patients who were overdue for colorectal cancer screening were randomly assigned to usual care or as much as six hours of "patient navigation." Study participants were 52 to 74 years old and spoke English, Haitian Creole, Portuguese, or Spanish as their primary language.

Patients in the intervention group received an introductory letter and an educational brochure from their primary care provider followed by a telephone call from a trained navigator fluent in the patient's primary language. Navigators provided education regarding colorectal cancer screening, helped motivate patients to undergo fecal occult blood testing or colonoscopy, helped them overcome insurance problems and other barriers to screening, and worked with a gastroenterologist's nurse to schedule colonoscopies. The nurse who was responsible for screening the patients once the navigator guided them through the process of colon screening served as a resource for patients and navigators, Lisa Valley-Shah, a staff nurse at Cambridge Health Alliance, told AJN.

Over one year, more patients in the intervention group than in the usual care group underwent colorectal cancer screening (33.6% versus 20%) and were screened by colonoscopy (26.4% versus 13%). Adenomas were also more likely to be detected in intervention patients (8.1% versus 3.9%), as were high-risk adenomas (2.5% versus 0.4%). Patient navigation was particularly useful for patients whose primary language wasn't English, who were older than 60 years, or who were black or white.

These findings suggest that patient navigation is an intervention that can be successfully integrated into the medical home model of primary care, the authors write, and could help reduce disparities in colorectal cancer screening.-Karen Rosenberg

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