Percac-Lima Sanja, Grant Richard W, Green Alexander R, Ashburner Jeffrey M, Gamba Gloria, Oo Sarah, Richter James M, Atlas Steven J
Chelsea HealthCare Center, Massachusetts General Hospital, Chelsea, MA 02150, USA.
J Gen Intern Med. 2009 Feb;24(2):211-7. doi: 10.1007/s11606-008-0864-x.
Minority racial/ethnic groups have low colorectal cancer (CRC) screening rates.
To evaluate a culturally tailored intervention to increase CRC screening, primarily using colonoscopy, among low income and non-English speaking patients.
Randomized controlled trial conducted from January to October of 2007.
Single, urban community health center serving a low-income, ethnically diverse population.
A total of 1,223 patients 52-79 years of age overdue for CRC screening, randomized to intervention (n = 409) vs. usual care control (n = 814) groups.
Intervention patients received an introductory letter with educational material followed by phone or in-person contact by a language-concordant "navigator." Navigators (n = 5) were community health workers trained to identify and address patient-reported barriers to CRC screening. Individually tailored interventions included patient education, procedure scheduling, translation and explanation of bowel preparation, and help with transportation and insurance coverage. Rates of colorectal cancer screening were assessed for intervention and usual care control patients.
Over a 9-month period, intervention patients were more likely to undergo CRC screening than control patients (27% vs. 12% for any CRC screening, p < 0.001; 21% vs. 10% for colonoscopy completion, p < 0.001). The higher screening rate resulted in the identification of 10.5 polyps per 100 patients in the intervention group vs. 6.8 in the control group (p = 0.04).
Patients were from one health center. Some patients may have obtained CRC screening outside our system.
A culturally tailored, language-concordant navigator program designed to identify and overcome barriers to colorectal cancer screening can significantly improve colonoscopy rates for low income, ethnically and linguistically diverse patients. ClinicalTrials.gov registration number: NCT00476970.
少数种族/族裔群体的结直肠癌（CRC）筛查率较低。
评估一种针对文化特点的干预措施，以提高低收入和非英语患者的CRC筛查率，主要采用结肠镜检查。
2007年1月至10月进行的随机对照试验。
为低收入、种族多样的人群服务的单一城市社区卫生中心。
共有1223名52 - 79岁逾期未进行CRC筛查的患者，随机分为干预组（n = 409）和常规护理对照组（n = 814）。
干预组患者收到一封附有教育材料的介绍信，随后由一名语言匹配的“导航员”进行电话或面对面联系。导航员（n = 5）是经过培训以识别和解决患者报告的CRC筛查障碍的社区卫生工作者。个性化干预措施包括患者教育、检查程序安排、肠道准备的翻译和解释以及交通和保险覆盖方面的帮助。对干预组和常规护理对照组患者的结直肠癌筛查率进行了评估。
在9个月的时间里，干预组患者比对照组患者更有可能接受CRC筛查（任何CRC筛查的比例分别为27%对12%，p < 0.001；结肠镜检查完成率分别为21%对10%，p < 0.001）。较高的筛查率导致干预组每100名患者中发现10.5个息肉，而对照组为6.8个（p = 0.04）。
患者来自一个卫生中心。一些患者可能在我们的系统之外进行了CRC筛查。
一个针对文化特点、语言匹配的导航员项目，旨在识别和克服结直肠癌筛查的障碍，可以显著提高低收入、种族和语言多样的患者的结肠镜检查率。ClinicalTrials.gov注册号：NCT00476970。
