Program eliminates gender disparities, boosts colonoscopy rates among Hispanic patients
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A culturally tailored patient navigation program improved colorectal cancer screening rates and reduced the gender gap in screenings among Hispanic patients, according to results published in Cancer.
“[A] low-cost and easy-to-implement intervention such as culturally tailored patient navigation can have a great impact on colorectal cancer screening utilization in the Hispanic population,” Abdul Saied Calvino, MD, MPH, of the department of surgery at Roger Williams Medical Center in Rhode Island, told Healio. “We all agree that colonoscopy is the standard of care for colorectal cancer prevention and early detection. Starting colorectal cancer colonoscopy screening at age 45 saves lives. But this life-saving procedure is underutilized by certain populations, not only because of limited access to care but because of cultural, language, and educational barriers that exist. Most of these barriers can be overcome with a culturally and language-sensitive navigation program.”
Intervention to increase screening rates
Calvino and colleagues developed a patient-centered program, tailored specifically to the Hispanic population in Rhode Island, to identify and overcome barriers to colonoscopy. They hired a Spanish-speaking navigator/coordinator and patients received an introductory letter in their native language, an initial phone call to help educate and navigate the health care system, and follow-up calls to determine whether potential obstacles to colonoscopy were overcome. Investigators recorded colonoscopy completion, cancellation and no-show rates and compared them with historical rates in Rhode Island.
During a 28-month period, 773 patients were referred to the program and 698 were enrolled (53% female and 47% male).
Results showed the overall colonoscopy completion rate was 85%, with no difference noted between men and women, compared with a nationwide rate of 40% to 50% completion among Hispanic adults. In addition, the colonoscopy cancellation rate was 9% and the no-show rate was 6%. Investigators noted cost and inability to contact patient after referral were the most common reasons for cancellation and no-shows.
According to researchers, 43% of patients within the colonoscopy completion group underwent polypectomy and 1.3% needed colectomy. Among those who completed the colonoscopy, 90% reported they would not have without the culturally tailored patient navigation program.
Overcoming gender gap
Calvino said underutilization of cancer screening procedures in economically, and culturally disadvantaged populations may increase the burden of cancer. He noted among the Hispanic community, the cultural “machismo” is correlated with lower colonoscopy rates; however, the results demonstrate that with appropriate education this barrier can be overcome the previously reported gender gap. By understanding this, physicians can design and implement effective interventions to increase cancer screening in Hispanic males and females.
“Culturally and language appropriate patient navigation is a low-cost intervention with a great impact in decreasing the gap in screening utilization by underserved populations,” Calvino said.
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Winkler, CS, et al. Cancer. 2022;doi:10.1002/cncr.34112.
Program may boost colorectal cancer screening among Hispanic adults and reduce related gender disparities. (website when embargo lifts) Published Feb. 7, 2022. Accessed Feb.7, 2022.
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