A program to enhance completion of screening colonoscopy among urban minorities.
OBJECTIVE
Although colonoscopy is becoming the preferred screening test for colorectal cancer, screening rates, particularly among minorities, are low. Little is known about the uptake of screening colonoscopy or the factors that predict colonoscopy completion among minorities. This study investigated the use of patient navigation within an open-access referral system and its effects on colonoscopy completion rates among urban minorities.


METHODS
This was a cohort study that took place at a teaching hospital in New York. Participants were mostly African Americans and Hispanics directly referred for screening colonoscopy by primary care clinics from November 2003 to May 2006. Once referred, a bilingual Hispanic female patient navigator facilitated the colonoscopy completion. Completion rates, demographic factors associated with completing colonoscopy, endoscopic findings, and patient satisfaction were analyzed.


RESULTS
Of 1169 referrals, 688 patients qualified for and 532 underwent navigation. Two thirds (66%) of navigated patients completed screening colonoscopies, 16% had adenomas, and only 5% had inadequate bowel preps. Women were 1.31 times more likely to complete the colonoscopy than men (P = .014). Hispanics were 1.67 times more likely to complete the colonoscopy than African Americans (P = .013). Hispanic women were 1.50 times more likely to complete the colonoscopy than Hispanic men (P = .009). Patient satisfaction was 98% overall, with 66% reporting that they definitely or probably would not have completed their colonoscopy without navigation.


CONCLUSIONS
By using a patient navigator, the majority of urban minorities successfully completed their colonoscopies, clinically significant pathology was detected, and patient satisfaction was enhanced. This approach may help increase adherence with screening colonoscopy efforts in other clinical settings.
Chen
Lea Ann
LA
Division of Gastroenterology, Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA.
Santos
Stephanie
S
Jandorf
Lina
L
Christie
Jennifer
J
Castillo
Anabella
A
Winkel
Gary
G
Itzkowitz
Steven
S
D018253:Adenoma, Villous / Q000175:diagnosis; D000554:Ambulatory Care Facilities; D044383:Black People; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000175:diagnosis; D003111:Colonic Polyps / Q000175:diagnosis; D003113:Colonoscopy / Q000706:statistics & numerical data*; D005260:Female; D040441:Health Educators; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D019303:Multilingualism; D009518:New York; D010349:Patient Compliance; D017060:Patient Satisfaction; D011320:Primary Health Care; D015397:Program Evaluation; D012017:Referral and Consultation; D017678:Sex Distribution; D019037:Urban Health Services; D014505:Urban Population; D001741:Black or African American