Journal article
Effect of Combined Patient Decision Aid and Patient Navigation vs Usual Care for Colorectal Cancer Screening in a Vulnerable Patient Population: A Randomized Clinical Trial
JAMA internal medicine, Vol.177(7), pp.967-974
07/01/2017
DOI: 10.1001/jamainternmed.2017.1294
PMCID: PMC5710456
PMID: 28505217
Abstract
Colorectal cancer (CRC) screening is underused, especially among vulnerable populations. Decision aids and patient navigation are potentially complementary interventions for improving CRC screening rates, but their combined effect on screening completion is unknown.
To determine the combined effect of a CRC screening decision aid and patient navigation compared with usual care on CRC screening completion.
In this randomized clinical trial, data were collected from January 2014 to March 2016 at 2 community health center practices, 1 in North Carolina and 1 in New Mexico, serving vulnerable populations. Patients ages 50 to 75 years who had average CRC risk, spoke English or Spanish, were not current with recommended CRC screening, and were attending primary care visits were recruited and randomized 1:1 to intervention or control arms.
Intervention participants viewed a CRC screening decision aid in English or Spanish immediately before their clinician encounter. The decision aid promoted screening and presented colonoscopy and fecal occult blood testing as screening options. After the clinician encounter, intervention patients received support for screening completion from a bilingual patient navigator. Control participants viewed a food safety video before the encounter and otherwise received usual care.
The primary outcome was CRC screening completion within 6 months of the index study visit assessed by blinded medical record review.
Characteristics of the 265 participants were as follows: their mean age was 58 years; 173 (65%) were female, 164 (62%) were Latino; 40 (15%) were white non-Latino; 61 (23%) were black or of mixed race; 191 (78%) had a household income of less than $20 000; 101 (38%) had low literacy; 75 (28%) were on Medicaid; and 91 (34%) were uninsured. Intervention participants were more likely to complete CRC screening within 6 months (68% vs 27%); adjusted-difference, 40 percentage points (95% CI, 29-51 percentage points). The intervention was more effective in women than in men (50 vs 21 percentage point increase, interaction P = .02). No effect modification was observed across other subgroups.
A patient decision aid plus patient navigation increased the rate of CRC screening completion in compared with usual care invulnerable primary care patients.
clinicaltrials.gov Identifier: NCT02054598.
Details
- Title: Subtitle
- Effect of Combined Patient Decision Aid and Patient Navigation vs Usual Care for Colorectal Cancer Screening in a Vulnerable Patient Population: A Randomized Clinical Trial
- Creators
- Daniel S Reuland - Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill2Division of General Medicine & Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill3Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel HillAlison T Brenner - Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill2Division of General Medicine & Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill3Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel HillRichard Hoffman - Department of Medicine, University of Iowa Carver College of Medicine, Iowa City5University of Iowa Holden Comprehensive Cancer Center, University of Iowa, Iowa City6Department of Family and Community Medicine, University of New Mexico School of Medicine, AlbuquerqueAndrew McWilliams - Department of Family Medicine, Carolinas HealthCare System, Charlotte, North CarolinaRobert L Rhyne - Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque8University of New Mexico Comprehensive Cancer Center, AlbuquerqueChristina Getrich - Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque9Department of Anthropology, University of Maryland, College ParkHazel Tapp - Department of Family Medicine, Carolinas HealthCare System, Charlotte, North CarolinaMark A Weaver - Division of General Medicine & Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill10Department of Biostatistics, University of North Carolina, Chapel HillDanelle Callan - University of New Mexico Comprehensive Cancer Center, AlbuquerqueLaura Cubillos - Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel HillBrisa Urquieta de Hernandez - Department of Family Medicine, Carolinas HealthCare System, Charlotte, North CarolinaMichael P Pignone - Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill2Division of General Medicine & Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill3Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill11Department of Internal Medicine, University of Texas Dell Medical School, Austin
- Resource Type
- Journal article
- Publication Details
- JAMA internal medicine, Vol.177(7), pp.967-974
- DOI
- 10.1001/jamainternmed.2017.1294
- PMID
- 28505217
- PMCID
- PMC5710456
- ISSN
- 2168-6106
- eISSN
- 2168-6114
- Grant note
- P30 CA086862 / NCI NIH HHS P30 DK056350 / NIDDK NIH HHS
- Language
- English
- Date published
- 07/01/2017
- Academic Unit
- Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984094536202771
Metrics
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