• Amy DeGroff, Paul C Schroy, Kerry Grace Morrissey, Beth Slotman, Elizabeth A Rohan, James Bethel, Jennifer Murillo, Weijia Ren, Shelley Niwa, Steven Leadbetter, and Djenaba Joseph.
• Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia. Electronic address: adegroff@cdc.gov.
• Am J Prev Med. 2017 Sep 1; 53 (3): 363-372.

IntroductionColorectal cancer is a leading cause of cancer-related death in the U.S. Although screening reduces colorectal cancer incidence and mortality, screening rates among U.S. adults remain less than optimal, especially among disadvantaged populations. This study examined the efficacy of patient navigation to increase colonoscopy screening.Study DesignRCT.Setting/ParticipantsA total of 843 low-income adults, primarily Hispanic and non-Hispanic blacks, aged 50-75 years referred for colonoscopy at Boston Medical Center were randomized into the intervention (n=429) or control (n=427) groups. Participants were enrolled between September 2012 and December 2014, with analysis following through 2015.InterventionTwo bilingual lay navigators provided individualized education and support to reduce patient barriers and facilitate colonoscopy completion. The intervention was delivered largely by telephone.Main Outcome MeasureColonoscopy completion within 6 months of study enrollment.ResultsColonoscopy completion was significantly higher for navigated patients (61.1%) than control group patients receiving usual care (53.2%, p=0.021). Based on regression analysis, the odds of completing a colonoscopy for navigated patients was one and a half times greater than for controls (95% CI=1.12, 2.03, p=0.007). There were no differences between navigated and control groups in regard to adequacy of bowel preparation (95.3% vs 97.3%, respectively).ConclusionsNavigation significantly improved colonoscopy screening completion among a racially diverse, low-income population. Results contribute to mounting evidence demonstrating the efficacy of patient navigation in increasing colorectal cancer screening. Screening can be further enhanced when navigation is combined with other evidence-based practices implemented in healthcare systems and the community.Copyright © 2017. Published by Elsevier Inc.

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