Increasing Colorectal Cancer Screening Among Hispanic Primary Care Patients: RE-AIM Analysis.

Context: Hispanic adults experience disparities in rates of colorectal cancer (CRC) screening. This RE-AIM analysis encompassed a multilevel decision support and navigation intervention (DSNI) for CRC screening. Interim findings were previously presented; we now aim to share the final analysis, particularly for effectiveness and implementation. Objective: Apply RE-AIM framework to a completed randomized controlled trial of a CRC screening intervention for Hispanic adults Setting: Five primary care practices Patients or Other Participants: Potential participants included a sampling frame of 2,720 screening-eligible patients, ages 50-75, Hispanic ethnicity, without history of CRC and polyps. 400 participants were enrolled. Intervention/Instrument: Decision support and navigation by a bilingual Patient Assistant (PA) as compared to a standard mailed intervention (SI) Main and Secondary Outcome Measures: 1) Reach- Study participants as compared to sampling frame 2) Effectiveness- Screening adherence 3) Adoption- Number of practice participants to complete intervention, engagement of patient and stakeholder advisory committee (PASAC) 4) Implementation- Quantitative data pertaining to patient contacts and communication of screening plan to primary care practices, Qualitative data on PA and Telephone Interviewer (TI) experiences 5) Maintenance- Health system dissemination (Pending). Results: 1) Reach- Study participants differed from the sampling frame in that ages 50-59 were overrepresented. There were no differences in race, gender, or language. 2) Effectiveness- Screening adherence was significantly increased in the DSNI group (73%) as compared to the SI group (44%) (OR=3.48, CI: 2.29-4.29,

Decision Support and Navigation to Increase Colorectal Cancer Screening among Hispanic Primary Care Patients.

The study compared the impact of a novel decision support and navigation intervention (DSNI) to a mailed standard intervention (SI) on colorectal cancer (CRC) screening among Hispanic patients from 5 primary care practices in the Lehigh Valley Health Network (LVHN). Methods. We randomized surveyed and consented patients who were 50 to 75 years of age and were eligible for CRC screening either to an SI Group (n = 200) or a DSNI Group (n = 200). Following randomization, SI Group participants were mailed a set of standard materials (i.e., a letter from the participant\u27s primary care practice encouraging selection and performance of either colonoscopy screening or a stool blood test (SBT) screening, a SBT kit, and instructions for arranging a colonoscopy appointment. Print materials were provided in English and Spanish. DSNI Group participants were also mailed the standard materials. In addition, DSNI participants received a telephone call from a bilingual patient navigator who reviewed the screening materials and verified the participant\u27s preferred CRC screening test. During the call, the patient navigator used an online Decision Counseling Program© (DCP) to determine the participant\u27s likelihood of test performance and to develop a personalized test preference- and likelihood-based screening plan. The plan was mailed to the participant and his/her primary care practice; and a participant screening status report was sent to the practice at 6 months. Finally, a 6-month survey was targeted to participants in both study groups. Results. Based on 6-month survey and medical records data, we found that CRC screening adherence was significantly higher (OR = 3.48, CI: 2.29, 5.29, P \u3c 0.001) in the DSNI Group (73%) versus the SI Group (44%). Conclusions. A decision support and navigation intervention significantly increased CRC screening adherence among Hispanic primary care patients