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Patient navigator program at barbershops boosts colon cancer screening in black men
A community-based, preclinical patient navigator program that recruited black men at local barbershops doubled the rate of colorectal cancer screening in this high-risk population.
The results of this randomized clinical trial — called the MISTER B trial, led by the Department of Population Health at NYU Langone Health — demonstrate the importance of basing patient navigators in community settings rather than in clinics, according to investigators.
“Although previous studies have shown that patient navigation improves colorectal cancer screening among ethnic minorities in clinical settings, our study is the first of this scale to look at a community approach,” Helen Cole, DrPH, former project coordinator at NYU Langone and current postdoctoral fellow at Institut Hospital del Mar d’Investigacions Mediques in Barcelona, Spain, said in a press release. “These findings add to the growing body of evidence that healthcare systems should expand their work in trusted community spaces to reach those who might not be seen in a clinical setting.”
Between 2010 and 2013, community health workers visited 111 barbershops throughout New York City and screened more than 4,000 black men aged older than 50 years to determine if they were up-to-date with screening for colorectal cancer. They identified 731 eligible men (who were also required to have uncontrolled high blood pressure; mean age, 57.4), whom Cole and colleagues then randomly assigned to one of three study arms.
Researchers paired the first group with a patient navigator who assisted them in scheduling an appointment for colorectal cancer screening, and helped address barriers to screening such as their lack of insurance coverage or their lack of knowledge about the need for screening, screening options and locations. The participants received follow-up phone calls from the patient navigators within 2 weeks and then periodically over 6 months to help schedule a colonoscopy or obtain a fecal immunochemical testing kit, and confirm completion.
For the control group, a trained counselor provided motivational interviewing for blood pressure control, and a third group received both interventions. Investigators also reviewed education materials on colorectal cancer screening and self-management of high blood pressure with all participants.
After 6 months, the men paired with patient navigators were significantly more likely to receive screening than those who were not; 17.5% in the first group and 17.8% of those who received both interventions completed screening compared with 8.4% of controls (P < .01).
The investigators noted that participants faced several barriers to obtaining adequate health care; just 60% reported having a personal physician, 40% had a check-up within the past year, 22.8% were uninsured and 73.6% had limited health literacy. Moreover, the average salary was $16,726, “an income low enough in New York City to make someone eligible for housing assistance,” according to the press release. Finally, almost a third had less than a high school education, and nearly half were unemployed.
“Black men are less likely than the general population to be insured and to have a personal doctor, which is why we went beyond the clinic and to the community,” Joseph Ravenell, MD, MPH, associate professor in the Department of Population Health at NYU Langone’s Center for Healthful Behavior Change, said in the press release. “Barbershops in particular hold special appeal for community-based intervention trials, are popular forums for open conversation, and could be leveraged to lessen the death rate from colorectal cancer in black men.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.