1B-1 COMBINING A COLORECTAL CANCER SCREENING DECISION AID AND PATIENT NAVIGATION IMPROVES DECISION MAKING PROCESSES AND SCREENING COMPLETION IN LINGUISTICALLY DIVERSE PRIMARY CARE PATIENTS

Monday, October 24, 2016: 2:00 PM
Bayshore Ballroom Salon E, Lobby Level (Westin Bayshore Vancouver)

Daniel S. Reuland, MD, MPH1, Alison Brenner, PhD2, Richard Hoffman, MD MPH3, Andrew McWilliams, MD MPH4, Robert Rhyne, MD MPH5, Hazel Tapp, PhD6, Mark Weaver, PhD7, Danelle Callan5, Khalil Harbi, MPH7, Brisa Hernandez, BUS6 and Michael Pignone, MD, MPH1, (1)University of North Carolina School of Medicine, Chapel Hill, NC, (2)Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, (3)University of Iowa, Iowa City, IA, (4)Carolinas Health Care, Charlotte, NC, (5)University of New Mexico School of Medicine, Albuquerque, NM, (6)Carolinas Healthcare System, Charlotte, NC, (7)University of North Carolina at Chapel Hill, Chapel Hill, NC
Purpose:

Colorectal cancer (CRC) screening decision aids and patient navigation address multiple different screening barriers and are potentially complementary interventions. We conducted a randomized controlled trial to determine the effect of a CRC screening decision aid plus patient navigation on decision making and screening completion outcomes in a diverse patient population. 

Method:

We enrolled patients aged 50-75 who were not up-to-date with recommended CRC screening and were attending primary care visits at safety-net clinics in Charlotte, NC and Albuquerque, NM. After a baseline survey, participants were randomized to view either a multi-media CRC screening decision aid in English or Spanish that presented colonoscopy and stool testing (FOBT/FIT) as screening options or a food safety video.  After the provider encounter, intervention patients received support for screening completion from a bilingual/bicultural patient navigator. Decision making outcomes included screening-related knowledge, discussions with the provider, and test preferences.  Screening completion was assessed by blinded chart review at six months. We used generalized estimating equations, controlling for study site and clustering by provider, to test for differences between groups. We used logistic regression to examine relationships between decision making outcomes and screening completion. 

Results:

Participant characteristics (n=264): mean age 58 years, 65% female, 61% Latino (71% of whom preferred Spanish); 16% White non-Latino; 16% Black non-Latino; 77% household income under $20,000; 40% low literacy; 30% Medicaid; 33% uninsured. Intervention participants had greater CRC screening knowledge, adj-diff 1.8 points out of 6 (95%CI 1.6, 2.1) and reported more screening discussions with providers (84% vs 41%); adj-diff 27% (95%CI 16%, 38%), including more frequent discussions of both FOBT/FIT and colonscopy options (24% vs 8%). Intervention participants were more likely to indicate a specific screening test preference (93% vs 65%); adj-diff 27% (95%CI 16%,38%) and more likely to prefer FOBT/FIT (67% vs. 46%).  Intervention participants were also more likely to complete CRC screening within 6 months: (66% vs 28%); adj-diff 38% (95%CI 27%, 49%). Screening completion was higher among those having greater knowledge (OR=1.28; 95%CI 1.05, 1.58), CRC screening discussions (OR=2.97; 95%CI 1.21, 4.38), and a specific screening test preference OR=3.6; (95%CI 1.7, 7.6).

Conclusion:

A combined decision aid plus patient navigation intervention substantially increases both CRC screening completion and the quality of the decision making process in linguistically diverse, vulnerable patients.

See more of: ORAL ABSTRACTS: CANCER SCREENING AND PREVENTION

See more of: 38th Annual North American Meeting of the Society for Medical Decision Making