Latino Peers as Patient Navigators for Colon Cancer Screening
| Status: | Completed |
|---|---|
| Conditions: | Colorectal Cancer, Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 50 - Any |
| Updated: | 4/21/2016 |
| Start Date: | January 2014 |
| End Date: | March 2015 |
Training Latinos as Peer Patient Navigators for Colon Cancer Screening
Disparities among racial and ethnic minorities remain prevalent despite advances in medical
science that make thes early detection and prevention of colorectal cancer a possibility for
all human kind. It is estimated that 90% of colorectal cancer deaths could be prevented
through screening. Unfortunately, among Latinos, colorectal cancer is the second leading
cause of cancer death. This rate is influenced by the fact that Latinos have the lowest
rates of colorectal cancer screening compared to other US racial groups. Moreover, Latinos
are more likely than whites to be diagnosed with advanced-stage colorectal cancer, when
treatment options are more limited. Lay health worker interventions for breast and cervical
cancer education and screening have demonstrated success in increasing both knowledge and
screening rates among racial and ethnic minorities. Additionally, our research has also
shown success in training African Americans as peer navigators to increase colorectal cancer
screening. Few lay health interventions, however, have been designed specifically for
colorectal cancer screening among Latinos. Thus, the purpose of this study is to expand peer
navigation for colorectal cancer screening to Latinos and increase their participation in
screening by training Latinos, who have had a colonoscopy, to help navigate other Latinos
through the colonoscopy screening procedure.
This study will focus on expanding the work of our research group by training Latino peers,
who are 50 years or older, have had a colonoscopy, and can model successful colonoscopy
screening completion to navigate Latino patients for screening. First, a training manual
will be developed which will be culturally specific to Latinos. Feedback and input from
community members will guide the development of the manual and training program. Second, the
training program will be carried out with six bilingual Latino peers, who will be taught to
master the core skills of patient navigation for screening colonoscopy. Finally, we will
gather preliminary information about the trained peers' ability to successfully navigate
patients for colonoscopy screening. If successful, this training program has the potential
to increase colonoscopy screening rates of Latinos and will be critical to the development
of future large-scale in interventions aimed at reducing advanced stage diagnosis of
colorectal cancer and ultimately colorectal cancer deaths among Latinos.
science that make thes early detection and prevention of colorectal cancer a possibility for
all human kind. It is estimated that 90% of colorectal cancer deaths could be prevented
through screening. Unfortunately, among Latinos, colorectal cancer is the second leading
cause of cancer death. This rate is influenced by the fact that Latinos have the lowest
rates of colorectal cancer screening compared to other US racial groups. Moreover, Latinos
are more likely than whites to be diagnosed with advanced-stage colorectal cancer, when
treatment options are more limited. Lay health worker interventions for breast and cervical
cancer education and screening have demonstrated success in increasing both knowledge and
screening rates among racial and ethnic minorities. Additionally, our research has also
shown success in training African Americans as peer navigators to increase colorectal cancer
screening. Few lay health interventions, however, have been designed specifically for
colorectal cancer screening among Latinos. Thus, the purpose of this study is to expand peer
navigation for colorectal cancer screening to Latinos and increase their participation in
screening by training Latinos, who have had a colonoscopy, to help navigate other Latinos
through the colonoscopy screening procedure.
This study will focus on expanding the work of our research group by training Latino peers,
who are 50 years or older, have had a colonoscopy, and can model successful colonoscopy
screening completion to navigate Latino patients for screening. First, a training manual
will be developed which will be culturally specific to Latinos. Feedback and input from
community members will guide the development of the manual and training program. Second, the
training program will be carried out with six bilingual Latino peers, who will be taught to
master the core skills of patient navigation for screening colonoscopy. Finally, we will
gather preliminary information about the trained peers' ability to successfully navigate
patients for colonoscopy screening. If successful, this training program has the potential
to increase colonoscopy screening rates of Latinos and will be critical to the development
of future large-scale in interventions aimed at reducing advanced stage diagnosis of
colorectal cancer and ultimately colorectal cancer deaths among Latinos.
Patients are being referred and scheduled for screening and diagnostic colonoscopy as part
of standard of care.
For research purposes, participants will be randomized to one of two kinds of patient
navigation:
1. Standard patient navigation (Pro-PN) receiving care that they would normally receive if
they were not participating in the study with patient navigation from the primary
mentor's staff.
2. Peer Patient Navigation (Peer-PN): Participants will be assisted by Latino/Hispanic
peers who have undergone colonoscopy, and are able to discuss, first-hand, their
personal experience undergoing colonoscopy and describe how they coped effectively with
the procedure. Medical advice will not be given.
Both groups will receive 3 intervention phone calls from their assigned navigators: 1) to
schedule the colonoscopy 2) a reminder call two weeks before the procedure and 3) a reminder
call three days before the procedure. PPN's will undergo three months of training supervised
by Dr. Sly (who will be mentored/supervised by Dr. Itzkowitz and Professor Jandorf).
Multiple modes of training will be used (didactic discussion, observation, role-playing,
one-on-one sessions, ongoing feedback, rehearsal, supervision (by study investigator and
mentors) via review of audio-tape recordings of Latino peers' navigation phone calls to the
participants and a take-home training manual).
Patients receiving standard patient navigation will receive the care and assessments that
they would normally receive if they were not participating in a study. Patients in the
Peer-PN group will be guided through the colonoscopy process by a Latino/Hispanic peer who
has undergone colonoscopy and will provide the personal prospective of how they coped with
the procedure.
At some point before the colonoscopy procedure, patients will receive a phone call, during
which a research assistant will administer a questionnaire in the form of an interview.
Study staff will assess health care behavior, fear of colonoscopy and concerns about CRC
screening, medical mistrust, interpersonal communication, social influence, and
self-efficacy. A medical chart review will also be completed after the colonoscopy for all
patients to assess completion of the examination as well as prep quality and any findings
where additional clinical follow-up was required. Colonoscopy results will also be collected
to assess quality of care and measure the efficacy of Peer-PN navigations compared to
standard navigation, particularly potential differences based on study group, i.e.,
compliance. No other information outside of standard of care will be collected.
of standard of care.
For research purposes, participants will be randomized to one of two kinds of patient
navigation:
1. Standard patient navigation (Pro-PN) receiving care that they would normally receive if
they were not participating in the study with patient navigation from the primary
mentor's staff.
2. Peer Patient Navigation (Peer-PN): Participants will be assisted by Latino/Hispanic
peers who have undergone colonoscopy, and are able to discuss, first-hand, their
personal experience undergoing colonoscopy and describe how they coped effectively with
the procedure. Medical advice will not be given.
Both groups will receive 3 intervention phone calls from their assigned navigators: 1) to
schedule the colonoscopy 2) a reminder call two weeks before the procedure and 3) a reminder
call three days before the procedure. PPN's will undergo three months of training supervised
by Dr. Sly (who will be mentored/supervised by Dr. Itzkowitz and Professor Jandorf).
Multiple modes of training will be used (didactic discussion, observation, role-playing,
one-on-one sessions, ongoing feedback, rehearsal, supervision (by study investigator and
mentors) via review of audio-tape recordings of Latino peers' navigation phone calls to the
participants and a take-home training manual).
Patients receiving standard patient navigation will receive the care and assessments that
they would normally receive if they were not participating in a study. Patients in the
Peer-PN group will be guided through the colonoscopy process by a Latino/Hispanic peer who
has undergone colonoscopy and will provide the personal prospective of how they coped with
the procedure.
At some point before the colonoscopy procedure, patients will receive a phone call, during
which a research assistant will administer a questionnaire in the form of an interview.
Study staff will assess health care behavior, fear of colonoscopy and concerns about CRC
screening, medical mistrust, interpersonal communication, social influence, and
self-efficacy. A medical chart review will also be completed after the colonoscopy for all
patients to assess completion of the examination as well as prep quality and any findings
where additional clinical follow-up was required. Colonoscopy results will also be collected
to assess quality of care and measure the efficacy of Peer-PN navigations compared to
standard navigation, particularly potential differences based on study group, i.e.,
compliance. No other information outside of standard of care will be collected.
Inclusion Criteria:
- Referred for a screening or diagnostic colonoscopy by a primary care physician
- 50 years or older
- Identify as Hispanic or Latino
- Provide informed consent in Spanish or English
- Have access to a working telephone
Exclusion Criteria:
- Personal history of colon cancer
- Personal history of any chronic gastrointestinal disorder (i.e., colitis, irritable
bowel syndrome)
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