A patient navigator who speaks the patient’s language and has time to spend answering questions and removing barriers makes a difference in whether that patient will get colorectal screening.
A study in Boston randomly assigned community patient navigators to half of a diverse group of low-income patients who were behind in colorectal cancer screening. Compared to patients who received usual health care, patients who got help from a patient navigator were more likely to complete screening, have a colonoscopy, and have polyps detected and removed.
After getting an introductory letter from their primary care doctor, patients in four community health centers and two public hospital clinics got a call from a patient navigator who spoke their language. The navigator helped them decide how they wanted to be screened — with fecal occult blood testing or colonoscopy.
Patients spoke English, Haitian Creole, Portuguese, or Spanish as their primary language.
For the 465 patients in the study, patients assigned navigators were more likely to:
- Be screened for colorectal cancer within one year (33.6 % vs 20%).
- Be screened using colonoscopy (26.4% vs 13%).
- Have adenomas (polyps) detected (8.1% vs 3.9%).
Use of a patient navigator was particularly helpful for blacks and those who didn’t speak English as a their primary language:
- 39.7 % of blacks in the navigator group were screened compared to 18.6 % in the usual care group.
- 39.8 % of non-English speakers helped by navigators got screened compared to 16.7 % who didn’t have a navigator.
The patient navigators were lay people in the community who guided patients through the medical and screening system, answering questions, helping them to get insurance, and arranging transportation and childcare. They were able to reach 7 out of 100 patients assigned to the program and contacted each individual a median of 8.5 times, spending an average of 107 minutes with each patient.
In a commentary, Thomas Bodenheimer, MD, of the University of California San Francisco, observed that the intervention worked because physicians had help from a team. He said,
In this era of primary-care-physician shortage and excessive panel sizes [numbers of patients per physician], quality improvement requires reducing panel size or delegating responsibilities from the physician to a healthcare team.
Writing in the Archives of Internal Medicine, Karen E. Lasser, MD, MPH and her colleagues concluded,
Patient navigation increased completion of CRC screening among ethnically diverse patients. Targeting patient navigation to black and non–English-speaking patients may be a useful approach to reducing disparities in CRC screening.
SOURCE: Lasser et al., Archives of Internal Medicine, Volume 171, Number 10, May 23, 2011. doi:10.1001/archinternmed.2011.201