AuBuchon Katarina E, Schubel Laura C, Rivera Jessica N Rivera, Garner Demetrie, Tran Jennifer, Urdinola Sophia, Arem Hannah
Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
Implementation Science, Healthcare Delivery Research Network, MedStar Health Research Institute, Washington, DC, USA.
BMC Health Serv Res. 2025 Jul 28;25(1):983. doi: 10.1186/s12913-025-13185-8.
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.
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.
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.
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.
在美国，黑人在结直肠癌（CRC）筛查机会方面存在不平等现象，这导致了CRC治疗结果的不平等。美国的拉丁裔人群筛查率较低（53.4%，而白人为70.4%），CRC是该人群所有癌症死亡的主要原因。患者导航是一种基于证据的提高CRC筛查率的方法，但这种方法并不经常大规模实施。我们就CRC筛查的障碍和促进因素，以及在大西洋中部医疗系统中为黑人和拉丁裔患者扩大患者导航项目的问题，采访了患者和医疗服务提供者。
我们采访了符合筛查条件（年龄45 - 75岁）的患者（n = 15；46.7%为黑人，53.3%为拉丁裔）和医疗系统合作伙伴（n = 12；42%为初级保健，33%为胃肠病学，25%为系统级管理）。访谈采用西班牙语和英语进行，对回答进行务实的主题分析，以定性方式分析，为项目实施提供参考。
几乎所有患者和合作伙伴都认为，CRC教育和筛查教育是及时进行筛查的障碍，并将导航员视为教育中介。患者表示，粪便检测和结肠镜检查的教育是明智决策的重要组成部分，导航员可以提供便利。导航员还可以为解决或克服情绪或实际障碍提供支持。导航员还具有独特的地位，通过与患者进行清晰、直接和及时的沟通，建立信任关系。医疗系统合作伙伴建议，导航员协助识别需要进行CRC筛查的患者，并促进关于筛查完成情况的闭环沟通。实施患者导航项目的预期障碍包括初级保健提供者和临床管理人员的支持。
实施CRC导航被视为解决黑人和拉丁裔患者完成CRC筛查的多层次障碍的潜在解决方案。未来的工作可以考虑确定有效的实施策略，以确保最大程度的导航覆盖范围和有效性。
