Patient Navigation for Colonoscopy Completion: Results of an RCT
Patient Navigation for Colonoscopy Completion: Results of an RCT
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DOI：
10.1016/j.amepre.2017.05.010
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发表时间：
2017-09-01
影响因子：
5.5
通讯作者：
Joseph, Djenaba
中科院分区：
文献类型：
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作者：
DeGroff, Amy;Schroy, Paul C., III;Joseph, Djenaba
简介：结直肠癌是美国癌症相关死亡的主要原因，尽管筛查降低了结直肠癌的发病率和死亡率，但美国成年人的筛查率仍然低于最佳水平，特别是在弱势群体中。本研究探讨了患者导航的有效性，以增加colonoscopy screen.Study设计：随机对照试验。设置/参与者：共843名低收入的成年人，主要是西班牙裔和非西班牙裔黑人，年龄在50-75岁，在波士顿医学中心结肠镜检查被随机分为干预组（n = 429）或对照组（n = 427）。参与者于2012年9月至2014年12月期间入组，分析持续到2015年。干预：两名双语非专业导航员提供个性化教育和支持，以减少患者障碍，促进结肠镜检查完成。干预主要通过电话进行。主要结果测量：研究入组后6个月内完成结肠镜检查。结果：导航患者（61.1%）的结肠镜检查完成率显著高于接受常规护理的对照组患者（53.2%，p = 0.021）。基于回归分析，导航患者完成结肠镜检查的几率是对照组的1.5倍（95% CI = 1.12，2.03，p = 0.007）。导航组和对照组在肠道准备充分性方面没有差异（分别为95.3%和97.3%）。结论：导航显著提高了种族多样性低收入人群中结肠镜筛查的完成率。这些结果为证明患者导航在增加结直肠癌筛查方面的有效性提供了越来越多的证据。当导航与医疗保健系统和社区实施的其他循证实践相结合时，可以进一步加强筛查。(C)2017由Elsevier Inc.出版美国预防医学杂志（American Journal of Preventive Medicine）
Introduction: Colorectal 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 design: RCT.Setting/participants: A 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.Intervention: Two 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 measure: Colonoscopy completion within 6 months of study enrollment.Results: Colonoscopy 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).Conclusions: Navigation 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. (C) 2017 Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine