Patient and provider perspectives on implementing patient navigation for colorectal cancer screening for Black and Latine patients: a qualitative study.

BACKGROUND

In the United States, Black people experience inequities in colorectal cancer (CRC) screening access, contributing to CRC outcome inequities. Latine people in the US and have lower screening rates (53.4% vs. 70.4% for White people), and CRC is the leading cause of all cancer death among this population. Patient navigation is an evidence-based approach to increase CRC screening, however it is not often implemented at scale. We interviewed patients and providers about barriers and facilitators to CRC screening and scaling a patient navigation program for Black and Latine patients in a mid-Atlantic healthcare system.

METHODS

We interviewed screening-eligible (age 45-75) patients (n = 15; 46.7% Black, 53.3% Latine) and healthcare system partners (n = 12; 42% primary care, 33% gastroenterology, and 25% systems-level administration). Interviews were in Spanish and English, and responses were analyzed qualitatively with a pragmatic thematic analysis to inform program implementation.

RESULTS

Nearly all patients and partners identified that CRC education and screening education were barriers to timely screening, and identified navigators as education brokers. Patients expressed that education on stool tests and colonoscopies is an essential part of informed decision-making, and can be facilitated by navigators. Navigators can also provide support for addressing or overcoming emotional or practice barriers. Navigators are further uniquely positioned to foster a trusting relationship through clear, direct, and timely communication with patients. Healthcare system partners suggested that navigators assist in identifying patients in need of CRC screening and facilitating closed-loop communication about screening completion. Anticipated barriers to implementation of a patient navigation program included buy-in from primary care providers and clinical administrators.

CONCLUSIONS

Implementing CRC navigation was perceived as a potential solution to multilevel barriers to CRC completion for Black and Latine patients. Future work may consider identifying effective implementation strategies to ensure maximum navigation reach and effectiveness.