Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 2307 Carol G. Belk Building, Mail Stop 529, Greenville, NC, 27858, USA.
Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
J Cancer Educ. 2021 Aug;36(4):670-676. doi: 10.1007/s13187-019-01684-2.
Black adults complete colonoscopies at lower rates than other groups despite increased colorectal cancer risk. Patient navigation represents a strategy to address the varied factors that influence colonoscopy completion, but few reports describe how navigation reduces racial disparities in colorectal cancer screening rates. The purpose of this study was to understand how a statewide colonoscopy navigation program addressed the challenges faced by low-income Black adults attempting to complete screening colonoscopy. A qualitative case study analysis was conducted at a participating clinical site of a statewide colonoscopy navigation program. Clinical observations, document reviews, and semi-structured interviews were conducted with patients, patient navigators, and clinical staff. Patient participants were recruited to ensure maximum variation related to gender and colonoscopy completion. Thematic coding allowed researchers to examine experiences, perceptions, and emotions related to patient navigation. In total, 31 interviews were completed between October 2014 and February 2015. Patients and patient navigators reported logistical, psychosocial, and knowledge-related barriers to colonoscopy completion. Clinical staff reports focused mostly on logistical barriers. Benefits of patient navigation also varied by participant type with clinical staff revealing positive effects on the clinic's relationships with referring specialty practices. Patient navigators address barriers that are important to patients, but often unseen by clinical staff/providers. New information about the benefits different stakeholders derive from this strategy was revealed. Together these findings provide insight into the processes associated with this strategy and novel information about the appeal of patient navigation to various stakeholders.
黑人成年人完成结肠镜检查的比例低于其他人群，尽管他们患结直肠癌的风险增加。患者导航代表了一种解决影响结肠镜检查完成的各种因素的策略，但很少有报告描述导航如何减少结直肠癌筛查率的种族差异。本研究的目的是了解全州范围内的结肠镜检查导航计划如何解决低收入黑人成年人试图完成筛查结肠镜检查所面临的挑战。在全州范围内结肠镜检查导航计划的一个参与临床站点进行了定性案例研究分析。对患者、患者导航员和临床工作人员进行了临床观察、文件审查和半结构化访谈。招募患者参与者以确保与性别和结肠镜检查完成情况相关的最大差异。主题编码使研究人员能够检查与患者导航相关的经验、看法和情绪。总共在 2014 年 10 月至 2015 年 2 月期间完成了 31 次访谈。患者和患者导航员报告了完成结肠镜检查的后勤、心理社会和知识相关障碍。临床工作人员的报告主要集中在后勤障碍上。患者导航的好处也因参与者类型而异，临床工作人员揭示了该策略对诊所与转诊专业实践的关系的积极影响。患者导航员解决了对患者很重要但临床工作人员/提供者通常看不到的障碍。不同利益相关者从这种策略中获得的好处的新信息也被揭示出来。这些发现共同提供了对该策略相关过程的深入了解，并提供了有关患者导航对不同利益相关者吸引力的新信息。
