Decision Support and Navigation to Increase Colorectal Cancer Screening among Hispanic Patients.

Background: Effective strategies are needed to raise colorectal cancer (CRC) screening rates among Hispanics Methods: We surveyed and randomized 400 Hispanic primary care patients either to a Decision Support and Navigation Intervention (DSNI) Group (n=197) or a Standard Intervention (SI) Group (n=203). Both groups received a CRC screening kit (bilingual informational booklet, fecal immunochemical stool blood test (SBT), and colonoscopy screening instructions). The DSNI Group received a telephone contact from a patient navigator. The navigator clarified screening test preference and likelihood of test performance, helped to develop a screening plan, and provided guidance through test performance. An endpoint telephone survey and medical chart review were completed. Multivariable analyses were conducted to assess 12-month screening adherence, change in decision stage, and knowledge and perceptions. Results: Screening adherence was significantly higher in the DSNI Group than the SI Group (OR = 4.8, 95% CI: 3.1 to 7.6). The DSNI Group, compared to the SI Group, also displayed higher SBT screening (OR = 4.2, 95% CI: 2.6, 6.7), higher colonoscopy screening (OR = 8.8, 95% CI = 4.1, 18.7), and greater forward change in screening decision stage (OR = 4.9, 95% CI = 2.6, 9.5). At endpoint, study groups did not differ in screening knowledge or perceptions. Conclusions: The DSNI had a greater positive impact on CRC screening outcomes than the SI. Impact: Health system implementation of DSNI strategies may help to reduce Hispanic CRC screening disparities in primary care.