Increasing colon cancer screening in primary care among African Americans

J Natl Cancer Inst. 2014 Dec 6;106(12):dju344. doi: 10.1093/jnci/dju344. Print 2014 Dec.


Background: The study aimed to determine the effect of preference-based tailored navigation on colorectal cancer (CRC) screening adherence and related outcomes among African Americans (AAs).

Methods: We conducted a randomized controlled trial that included 764 AA patients who were age 50 to 75 years, were eligible for CRC screening, and had received care through primary care practices in Philadelphia. Consented patients completed a baseline telephone survey and were randomized to either a Standard Intervention (SI) group (n = 380) or a Tailored Navigation Intervention (TNI) group (n = 384). The SI group received a mailed stool blood test kit plus colonoscopy instructions, and a reminder. The TNI group received tailored navigation (a mailed stool blood test kit or colonoscopy instructions based on preference, plus telephone navigation) and a reminder. A six-month survey and a 12-month medical records review were completed to assess screening adherence, change in overall screening preference, and perceptions about screening. Multivariable analyses were performed to assess intervention impact on outcomes.

Results: At six months, adherence in the TNI group was statistically significantly higher than in the SI group (OR = 2.1, 95% CI = 1.5 to 2.9). Positive change in overall screening preference was also statistically significantly greater in the TNI group compared with the SI group (OR = 1.5, 95% CI = 1.0 to 2.3). There were no statistically significant differences in perceptions about screening between the study groups.

Conclusions: Tailored navigation in primary care is a promising approach for increasing CRC screening among AAs. Research is needed to determine how to maximize intervention effects and to test intervention impact on race-related disparities in mortality and survival.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Americans / statistics & numerical data*
  • Aged
  • Colonic Neoplasms / diagnosis
  • Colonic Neoplasms / ethnology*
  • Colonic Neoplasms / mortality
  • Colonic Neoplasms / prevention & control*
  • Colonoscopy
  • Early Detection of Cancer / methods*
  • Early Detection of Cancer / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Mass Screening / methods
  • Mass Screening / statistics & numerical data
  • Middle Aged
  • Occult Blood
  • Patient Compliance / statistics & numerical data
  • Patient Navigation* / methods
  • Philadelphia / epidemiology
  • Primary Health Care / statistics & numerical data*
  • Primary Prevention / methods
  • Reminder Systems*
  • Telephone