title: Implementation of culturally targeted patient navigation system for screening colonoscopy in a direct referral system.
abstract: Low-income minorities often face system-based and personal barriers to screening colonoscopy (SC). Culturally targeted patient navigation (CTPN) programs employing professional navigators (Pro-PNs) or community-based peer navigators (Peer-PNs) can help overcome barriers but are not widely implemented. In East Harlem, NY, USA, where approximately half the residents participate in SC, 315 African American patients referred for SC at a primary care clinic with a Direct Endoscopic Referral System were recruited between May 2008 and May 2010. After medical clearance, 240 were randomized to receive CTPN delivered by a Pro-PN (n = 106) or Peer-PN (n = 134). Successful navigation was measured by SC adherence rate, patient satisfaction and navigator trust. Study enrollment was 91.4% with no significant differences in SC adherence rates between Pro-PN (80.0%) and Peer-PN (71.3%) (P = 0.178). Participants in both groups reported high levels of satisfaction and trust. These findings suggest that CTPN Pro-PN and Peer-PN programs are effective in this urban primary care setting. We detail how we recruited and trained navigators, how CTPN was implemented and provide a preliminary answer to our questions of the study aims: can peer navigators be as effective as professionals and what is the potential impact of patient navigation on screening adherence?
authors: Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029-6574, USA, Population Studies and Disparities Research Program, Department of Oncology, School of Medicine, Karmanos Cancer Institute, Wayne State University, 4100 John R, MM03CB Detroit, MI 48201, USA and Mailman School of Public Health, Columbia University, 722 West, 168th Street, New York, NY 10032, USA.
authors: Lina
authors: L
authors: Jandorf
authors: Julia L
authors: JL
authors: Cooperman
authors: Lauren M
authors: LM
authors: Stossel
authors: Steven
authors: S
authors: Itzkowitz
authors: Hayley S
authors: HS
authors: Thompson
authors: Cristina
authors: C
authors: Villagra
authors: Linda D
authors: LD
authors: Thélémaque
authors: Thomas
authors: T
authors: McGinn
authors: Gary
authors: G
authors: Winkel
authors: Heiddis
authors: H
authors: Valdimarsdottir
authors: Rachel C
authors: RC
authors: Shelton
authors: William
authors: W
authors: Redd
mesh_terms: D001741:Black or African American; D003113:Colonoscopy / Q000523:psychology*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D054521:Cultural Competency; D006801:Humans; D009519:New York City / Q000453:epidemiology; D010349:Patient Compliance; D062526:Patient Navigation / Q000458:organization & administration*; D017060:Patient Satisfaction; D010379:Peer Group; D011203:Poverty; D016730:Program Development; D012017:Referral and Consultation; D035502:Trust
references: Cancer Epidemiol Biomarkers Prev. 2007 Jun;16(6):1298-302
references: 17548702
references: Prev Chronic Dis. 2011 Jan;8(1):A20
references: 21159232
references: J Consult Clin Psychol. 1993 Apr;61(2):291-5
references: 8473583
references: Prev Med. 2005 Jul;41(1):23-9
references: 15916989
references: Cancer. 2005 Aug 15;104(4):848-55
references: 16010658
references: J Cancer Educ. 1996 Winter;11(4):210-5
references: 8989634
references: Cancer Control. 2008 Apr;15(2):157-65
references: 18376383
references: Cancer Nurs. 2010 Mar-Apr;33(2):127-40
references: 20142736
references: J Gen Intern Med. 2008 May;23(5):699-705
references: 18338215
references: J Clin Gastroenterol. 2011 May-Jun;45(5):e47-53
references: 21030874
references: J Urban Health. 2006 Mar;83(2):231-43
references: 16736372
references: Prev Med. 2004 May;38(5):536-50
references: 15066356
references: Gastroenterology. 2008 May;134(5):1570-95
references: 18384785
references: Clin Gastroenterol Hepatol. 2008 Apr;6(4):443-50
references: 18304882
references: Cancer. 2011 Aug;117(15 Suppl):3603-17
references: 21780095
references: J Gen Intern Med. 2009 Feb;24(2):211-7
references: 19067085
references: Fam Med. 2005 May;37(5):341-7
references: 15883900
references: Am J Public Health. 2010 Oct;100(10):1912-6
references: 20724684
references: Ann Intern Med. 2008 Nov 4;149(9):627-37
references: 18838716
references: Am J Prev Med. 2009 Jul;37(1):1-7
references: 19423273
references: Health Educ Res. 2009 Apr;24(2):318-29
references: 18463411
references: CA Cancer J Clin. 2010 Mar-Apr;60(2):99-119
references: 20228384
references: Cancer. 2007 Jan 15;109(2 Suppl):359-67
references: 17123275
references: J Gen Intern Med. 2005 Nov;20(11):989-95
references: 16307622
references: AIDS Educ Prev. 1994 Feb;6(1):40-52
references: 8024942
references: Ethn Dis. 2009 Summer;19(3):323-9
references: 19769016
references: Surg Oncol Clin N Am. 2005 Oct;14(4):655-69, v
references: 16226685
references: Cancer Epidemiol Biomarkers Prev. 2009 Aug;18(8):2170-5
references: 19622721
references: J Cancer Educ. 2010 Mar;25(1):70-5
references: 20082178
references: Cancer Causes Control. 2010 Nov;21(11):1931-40
references: 20676928
references: Am J Community Psychol. 1998 Oct;26(5):705-43
references: 9861691
references: Health Educ Res. 2001 Oct;16(5):555-66
references: 11675803
references: Am J Gastroenterol. 2009 Mar;104(3):739-50
references: 19240699
references: J Gen Intern Med. 2005 Nov;20(11):977-83
references: 16307620
references: Health Educ Behav. 2003 Apr;30(2):133-46
references: 12693519
references: Cancer Pract. 1995 Jan-Feb;3(1):19-30
references: 7704057
references: N Engl J Med. 1993 Dec 30;329(27):1977-81
references: 8247072
references: J Cancer Educ. 2011 Jun;26(2):277-84
references: 21287311
references: J Urban Health. 2007 Jan;84(1):32-44
references: 17186375
references: J Gen Intern Med. 2011 Feb;26(2):123-9
references: 20931294
references: Can Assoc Radiol J. 2004 Jun;55(3):145-50
references: 15237774
references: Nurs Res. 2004 Nov-Dec;53(6):396-405
references: 15586136
references: MMWR Morb Mortal Wkly Rep. 2010 Jul 9;59(26):808-12
references: 20613704
references: J Gen Intern Med. 2008 Jan;23(1):58-63
references: 18030540
references: Nurs Res. 2007 Jan-Feb;56(1):18-27
references: 17179870
references: Cancer Epidemiol Biomarkers Prev. 2011 Aug;20(8):1580-98
references: 21653645
references: Patient Educ Couns. 2008 Aug;72(2):210-7
references: 18467066
references: Cancer Pract. 2002 Sep-Oct;10(5):240-7
references: 12236837