Patient Navigators Boost Colon Screens in Urban Minorities

Personal interventions cut no-show rates 30%, study finds

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FRIDAY, April 4, 2008 (HealthDay News) -- Two new studies make the case that more personal guidance and encouragement will help increase the numbers of low-income and minority patients getting recommended screening for colorectal cancer.

The studies, published in current issue of Clinical Gastroenterology and Hepatology, found problems with large "safety net" health-care systems serving urban populations and hope for patient intervention programs featuring "navigators" that guide patients through preparation for the procedure and encourage their attendance.

Colon cancer, when detected early, is one of the most treatable of all cancers, with a five-year survival rate of 90 percent. However, diagnosis in the most advanced stage of the disease causes that survival rate to drop only 10 percent. The American Gastroenterological Association Institute estimates 148,800 people will be diagnosed with colorectal cancer in 2008, and almost 50,000 will die from the preventable disease.

In the first study, a research team studied six months of endoscopy laboratory scheduling and procedure logs from Denver Health Medical Center. They found 41.7 percent of the 817 people scheduled for outpatient colonoscopies failed to show. Of those who did make their appointments, 30.2 percent did not prepare their bowel properly to take the examination.

According to the Denver study, such safety net systems traditionally have a large proportion of low-income and minority patients, and their colonoscopy no-show rates are "very high." The researchers said the rate of colonoscopy non-attendance at Denver Health is comparable to similar institutions in the United States but much greater than the no-show rate at non-safety-net systems.

"Because the rationale and required steps for completing colonoscopy are complex, individual intervention with patient navigators -- non-clinical individuals who are specially trained to navigate the health-care system -- may be particularly helpful. Published accounts show that they have been very successful in minority community health centers and public hospitals in the U.S.," Dr. Thomas D. Denberg, of the University of Colorado Denver School of Medicine, said in a prepared statement.

His point is supported by the second study in which researchers from Mount Sinai School of Medicine, in New York City, and the City University of New York provided 532 colonoscopy patients with a patient navigator. Of these patients, 67 percent went to their colonoscopies, and only 5 percent of them had inadequate bowel preparation. The no-show rate among urban minorities also fell from an average of 40 percent (prior to the navigator program) to 9.8 percent.

"Our results show that introducing a patient navigator is effective in increasing colonoscopy completion rates in urban minorities, which not only directly benefits the patient, but should translate into greater efficiency and cost savings for endoscopy units," Dr. Steven H. Itzkowitz, of Mount Sinai School of Medicine, said in a prepared statement.

More information

The National Cancer Institute has more about colorectal screening.

SOURCE: American Gastroenterological Association Institute, news release, April 1, 2008

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