Personal navigation increases colorectal cancer screening uptake.
BACKGROUND
Prior randomized, controlled trials (RCTs) indicate that patient navigation can boost colorectal cancer screening rates in primary care. The sparse literature on pragmatic trials of interventions designed to increase colorectal cancer screening adherence motivated this trial on the impact of a patient navigation intervention that included support for performance of the participants' preferred screening test (colonoscopy or stool blood testing).


METHODS
Primary care patients (n = 5,240), 50 to 74 years of age, with no prior diagnosis of bowel cancer and no record of a recent colorectal cancer screening test, were identified at the Group Health Centre in northern Ontario. These patients were randomly assigned to an intervention group (n = 2,629) or a usual care control group (n = 2,611). Intervention group participants were contacted by a trained nurse navigator by telephone to discuss colorectal cancer screening. Interested patients met with the navigator, who helped them identify and arrange for performance of the preferred screening test. Control group participants received usual care. Multivariate analyses were conducted using medical records data to assess intervention impact on screening adherence within 12 months after randomization.


RESULTS
Mean patient age was 59 years, and 50% of participants were women. Colorectal cancer screening adherence was higher in the intervention group (35%) than in the control group (20%), a difference that was statistically significant (OR, 2.11; confidence interval, 1.87-2.39).


CONCLUSIONS
Preference-based patient navigation increased screening uptake in a pragmatic RCT.


CONCLUSIONS
Patient navigation increased colorectal cancer screening rates in a pragmatic RCT in proportions similar to those observed in explanatory RCTs.
School of Kinesiology and Health Science, York University and Research, Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada. paul.ritvo@cancercare.on.ca.
Paul G
PG
Ritvo
Kimmel Cancer Center, Division of Population Science, Department of Medical Oncology, Thomas Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
Ronald E
RE
Myers
Institute for Clinical Evaluative Sciences, Toronto-Sunnybrook Regional Cancer Centre, Sunnybrook Health Sciences Centre, Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
Lawrence F
LF
Paszat
Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Institute of Health Policy, Management, and Evaluation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Jill M
JM
Tinmouth
Group Health Centre, Sault Ste. Marie, Ontario, Canada.
Joshua
J
McColeman
Group Health Centre, Sault Ste. Marie, Ontario, Canada.
Brian
B
Mitchell
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Mardie
M
Serenity
Prevention and Cancer Control, Cancer Care Ontario, Institute for Clinical Evaluative Sciences, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Linda
L
Rabeneck
D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062526:Patient Navigation / Q000379:methods*; D011446:Prospective Studies