title: Effect of patient navigation on colorectal cancer screening in a community-based randomized controlled trial of urban African American adults.
abstract: OBJECTIVE
  In recent years, colorectal cancer (CRC) screening rates have increased steadily in the USA, though racial and ethnic disparities persist. In a community-based randomized controlled trial, we investigated the effect of patient navigation on increasing CRC screening adherence among older African Americans.
  
  
  METHODS
  Participants in the Cancer Prevention and Treatment Demonstration were randomized to either the control group, receiving only printed educational materials (PEM), or the intervention arm where they were assigned a patient navigator in addition to PEM. Navigators assisted participants with identifying and overcoming screening barriers. Logistic regression analyses were used to assess the effect of patient navigation on CRC screening adherence. Up-to-date with screening was defined as self-reported receipt of colonoscopy/sigmoidoscopy in the previous 10 years or fecal occult blood testing (FOBT) in the year prior to the exit interview.
  
  
  RESULTS
  Compared with controls, the intervention group was more likely to report being up-to-date with CRC screening at the exit interview (OR 1.55, 95 % CI 1.07-2.23), after adjusting for select demographics. When examining the screening modalities separately, the patient navigator increased screening for colonoscopy/sigmoidoscopy (OR 1.53, 95 % CI 1.07-2.19), but not FOBT screening. Analyses of moderation revealed stronger effects of navigation among participants 65-69 years and those with an adequate health literacy level.
  
  
  CONCLUSIONS
  In a population of older African Americans adults, patient navigation was effective in increasing the likelihood of CRC screening. However, more intensive navigation may be necessary for adults over 70 years and individuals with low literacy levels.
authors.affiliation: Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA. hisani.horne@nih.gov.|National Institutes of Health/NCI/DCEG/HREB, 9609 Medical Center Drive, Rm 7E234, MSC 7234, Bethesda, MD, 20892-7234, USA. hisani.horne@nih.gov.
authors.forename: Hisani N
authors.initials: HN
authors.lastname: Horne
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Darcy F
authors.initials: DF
authors.lastname: Phelan-Emrick
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Craig E
authors.initials: CE
authors.lastname: Pollack
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Markakis
authors.affiliation: Department of Oncology, Department of Acute and Chronic Care, Johns Hopkins School of Medicine, Baltimore, MD, USA.|Johns Hopkins University School of Nursing, Baltimore, MD, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wenzel
authors.affiliation: Department of Population, Family and Reproductive Health and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Saifuddin
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Department of Behavioral and Community Health, School of Public Health, University of Maryland College Park, College Park, MD, USA.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Garza
authors.affiliation: Health Partners Cancer Program and Institute for Education and Research, Minneapolis, MN, USA.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Shapiro
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Lee R
authors.initials: LR
authors.lastname: Bone
authors.affiliation: Park West Health Systems, Baltimore, MD, USA.
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Johnson
authors.affiliation: The Brooklyn Hospital Center, Brooklyn, NY, USA.
authors.forename: Jean G
authors.initials: JG
authors.lastname: Ford
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D009780:Occult Blood; D010353:Patient Education as Topic; D062526:Patient Navigation / Q000379:methods / Q000706:statistics & numerical data*; D012812:Sigmoidoscopy / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014505:Urban Population