Decision Support and Navigation to Increase Colorectal Cancer Screening Among Hispanic Patients.

BACKGROUND: Effective strategies are needed to raise colorectal cancer screening rates among Hispanics.

METHODS: We surveyed and randomized 400 Hispanic primary care patients either to a Decision Support and Navigation Intervention (DSNI) Group ( n = 197) or a Standard Intervention (SI) Group ( n = 203). Both groups received a colorectal cancer screening kit [bilingual informational booklet, fecal immunochemical stool blood test (SBT), and colonoscopy screening instructions]. The DSNI Group received a telephone contact from a patient navigator. The navigator clarified screening test preference and likelihood of test performance, helped to develop a screening plan, and provided guidance through test performance. An endpoint telephone survey and medical chart review were completed. Multivariable analyses were conducted to assess 12-month screening adherence, change in decision stage, and knowledge and perceptions.

RESULTS: Screening adherence was significantly higher in the DSNI Group than the SI Group [OR, 4.8; 95% confidence interval (CI), 3.1-7.6]. The DSNI Group, compared with the SI Group, also displayed higher SBT screening [OR, 4.2; 95% CI, 2.6-6.7), higher colonoscopy screening (OR, 8.8; 95% CI, 4.1-18.7), and greater forward change in screening decision stage (OR, 4.9; 95% CI, 2.6-9.5). At endpoint, study groups did not differ in screening knowledge or perceptions.

CONCLUSIONS: The DSNI had a greater positive impact on colorectal cancer screening outcomes than the SI.

IMPACT: Health system implementation of DSNI strategies may help to reduce Hispanic colorectal cancer screening disparities in primary care.