Abstract 5282: Implementing a colorectal cancer screening program: A navigation led effort in an urban community health center
Authors: Glaser Kathryn M. , Nichols Carly , Abrams Alyssa , Erwin Deborah O. , Reid Mary 
Published: August 2018

Abstract
Background: Colorectal cancer (CRC) screening is effective in preventing and detecting cancer at an early stage. Yet populations served by community health centers (CHCs) are screened at lower rates than the general population, and screening rates are even lower in non-English speaking populations. Time constraints during office visits often impede providers from discussing CRC screening, insufficient access to colonoscopy resources and facilities, and patients' fear regarding colonoscopy preparation and procedure are just some of the challenges CHCs face when promoting CRC screening. These issues are only compounded by significant language and cultural barriers.
Methods: We conducted a quality improvement initiative that serves as a case study to measure the increase in CRC screening rates over a one year period at a CHC with two clinic locations (intervention and non-intervention site) providing primary care to diverse and low-income populations. A pilot site was selected by the CHC to test an intervention using patient education and navigation, while the second site received no direct navigation intervention. The patient navigator assigned to the intervention site provided patient education and developed new patient education materials (visual), in addition to assistance in scheduling and coordinating services (transportation, interpreters, obtaining prep solution etc.) for the actual colonoscopy, as well as distributing fecal immunochemical testing (FIT) for those refusing or ineligible for a colonoscopy. Our rationale for the project, supported by preliminary data was that CHC providers want to increase screening rates, particularly in non-English speaking patients, but need tools and support to implement change.
Results: Between August 2016 and August 2017, the intervention site increased from 32% to 42% of eligible patients screened for CRC, with the most notable change in the non-English speaking patients (12% increase), primarily Burmese, Nepali and Spanish speaking, while there was only a 1% increase at the non-intervention site. Patient navigation efforts at the intervention site focused primarily on educating and navigating non-English speaking patients due to the increased barriers to understanding CRC and accessing preventative screening services. In total, 224 additional patients were screened for CRC during the intervention period with 86% of patients received screening colonoscopies over a FIT test.
Conclusions: Specialized and tailored education and navigation can be effective to increase CRC screening rates at CHCs, particularly in non-English speaking populations. Understanding how different populations think about CRC screening would inform navigation strategies on how to better promote screening in diverse populations and develop more targeted interventions.
Citation Format: Kathryn M. Glaser, Carly Nichols, Alyssa Abrams, Deborah O. Erwin, Mary Reid. Implementing a colorectal cancer screening program: A navigation led effort in an urban community health center [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5282.