Lasser Karen E, Murillo Jennifer, Lisboa Sandra, Casimir A Naomie, Valley-Shah Lisa, Emmons Karen M, Fletcher Robert H, Ayanian John Z
Section of General Internal Medicine, Boston Medical Center, USA.
Arch Intern Med. 2011 May 23;171(10):906-12. doi: 10.1001/archinternmed.2011.201.
Patient navigators may increase colorectal cancer (CRC) screening rates among adults in underserved communities, but prior randomized trials have been small or conducted at single sites and have not included substantial numbers of Haitian Creole-speaking or Portuguese-speaking patients.
We identified 465 primary care patients from 4 community health centers and 2 public hospital-based clinics who were not up-to-date with CRC screening and spoke English, Haitian Creole, Portuguese, or Spanish as their primary language. We enrolled participants from September 1, 2008, through March 31, 2009, and followed them up for 1 year after enrollment. We randomly allocated patients to receive a patient navigation-based intervention or usual care. Intervention patients received an introductory letter from their primary care provider with educational material, followed by telephone calls from a language-concordant navigator. The navigators offered patients the option of being screened by fecal occult blood testing or colonoscopy. The primary outcome was completion of any CRC screening within 1 year. Secondary outcomes included the proportions of patients screened by colonoscopy who had adenomas or cancer detected.
During a 1-year period, intervention patients were more likely to undergo CRC screening than control patients (33.6% vs 20.0%; P < .001), to be screened by colonoscopy (26.4% vs 13.0%; P < .001), and to have adenomas detected (8.1% vs 3.9%; P = .06). In prespecified subgroup analyses, the navigator intervention was particularly beneficial for patients whose primary language was other than English (39.8% vs 18.6%; P < .001) and black patients (39.7% vs 16.7%; P = .004).
Patient navigation increased completion of CRC screening among ethnically diverse patients. Targeting patient navigation to black and non-English-speaking patients may be a useful approach to reducing disparities in CRC screening.
clinicaltrials.gov Identifier: NCT01141114.
患者导航员可能会提高服务不足社区成年人的结直肠癌（CRC）筛查率，但先前的随机试验规模较小或在单一地点进行，且未纳入大量讲海地克里奥尔语或葡萄牙语的患者。
我们从4个社区卫生中心和2个公立医院诊所中确定了465名初级保健患者，他们未进行最新的CRC筛查，且以英语、海地克里奥尔语、葡萄牙语或西班牙语作为主要语言。我们于2008年9月1日至2009年3月31日招募参与者，并在入组后对他们进行了1年的随访。我们将患者随机分配接受基于患者导航的干预或常规护理。干预组患者收到其初级保健提供者的介绍信及教育材料，随后由语言匹配的导航员进行电话随访。导航员为患者提供粪便潜血检测或结肠镜检查的筛查选项。主要结局是在1年内完成任何CRC筛查。次要结局包括接受结肠镜检查且检测出腺瘤或癌症的患者比例。
在1年期间，干预组患者比对照组患者更有可能接受CRC筛查（33.6%对20.0%；P<.001），接受结肠镜检查（26.4%对13.0%；P<.001），以及检测出腺瘤（8.1%对3.9%；P=.06）。在预先设定的亚组分析中，导航员干预对主要语言不是英语的患者（39.8%对18.6%；P<.001）和黑人患者（39.7%对16.7%；P=.004）特别有益。
患者导航提高了不同种族患者的CRC筛查完成率。针对黑人和非英语患者进行患者导航可能是减少CRC筛查差异的一种有用方法。
clinicaltrials.gov标识符：NCT01141114。
