Tailored Navigation in Colorectal Cancer Screening

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Abstract
Background: Colorectal cancer (CRC) screening is underutilized. Effective methods to increase screening use are needed. This study sought to determine the impact of tailored navigation on CRC screening in primary care. Methods: The study included 154 primary care practice patients who were 50 or more years of age, were eligible for CRC screening, and had an office visit within 2 years before study initiation. Baseline telephone survey data were collected on participant sociodemographic characteristics, psychosocial factors, and screening test [fecal occult blood test (FOBT) or colonoscopy] decision stage. By comparing decision stage data, we identified that test with the highest decision stage (ie, preferred screening test). Participants who preferred FOBT were sent an FOBT kit and a reminder. Those preferring colonoscopy were sent colonoscopy instructions. After this mailing, a study patient navigator made a telephone call to guide participants towards screening. Six-month end point survey and medical records data were obtained. Univariable and multivariable analyses were performed to identify predictors of screening and of change in preferred screening test decision stage. Results: At end point, 63 (41%) study participants had screened. From baseline to end point, overall screening preference increased for 75 (63%) participants. Age and perceived salience and coherence (ie, screening is important and sensible) were positive, significant predictors of screening use (P = 0.02 and P = 0.05, respectively); while only age predicted change in overall screening preference (P = 0.03). Conclusions: Study participant screening use and preference increased. Age and attitudes predicted outcomes. Randomized trials are needed to determine intervention impact at the population level.