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Increasing Colorectal Cancer Screening Uptake with a Patient Navigator

Dr. Brian Mitchell, Co-Investigator

Northern Ontario Health Research ConferenceSudbury, ON

June 4-5, 2010

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GROUP HEALTH CENTRE

Ontario’s largest and longest established ambulatory health care organization providing excellence in health care to over half the population of Sault Ste. Marie for 47 years.

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PATIENT-FOCUSED TEAM Unique health organization 54,000 patients on our roster Not-for-profit Multi-disciplinary Multi-specialty Multi-site 61 Physician providers 9 Nurse Practitioners 180 other health care professionals

Electronic Medical Record since 1997

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Group Health Centre is the health care partnership of the Sault Ste. Marie and District Group Health Association and the Algoma District Medical Group. The two groups are linked together by a common objective – to provide excellent, innovative, and comprehensive health care to meet the needs of the community.

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Colorectal Cancer (CRC) Facts 2nd deadliest cancer in Canada

2nd leading cause of cancer-related death in both men and women

Ontario has one of the highest rates of CRC in the world

CRC is highly preventable -- 90% curable if detected in early stages

Ministry of Health and Longterm Care. (2010). ColonCancerCheck. What is Colon Cancer? www.health.gov.on.ca.

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Research Question:

Does tailored navigation provided by a registered nurse increase the

number of participants who undergo screening for colorectal cancer?

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Study Design 2 year randomized intervention trial

Experimental and control (delayed intervention) groups

Recruitment from participating Primary Care Provider practices located at GHC

Part of a series of investigations undertaken by the Canadian Institute for Health Research (CIHR) Emerging Team in Colorectal Cancer Screening, led by Linda Rabeneck, BSc, MD, MPH, FRCPC

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What is a Patient Navigator?

A trained health care professional who assumes responsibility for helping individuals through the process of care

Study role is to assist eligible patients to navigate the various screening options and decide which preferred option to act on

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PCP RecruitmentPrimary Care Providers (PCPs) located at GHC were invited to include their patient practice roster as potential participants in the study PCPs received a letter of invitation that outlined the

study objectives and the randomization process Study nurse visited PCP offices and provided a list of

their unscreened and under-screened patients PCPs agreed to sign a recruitment letter that would be

sent to their patients

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Eligible Participants Men and women age 50 – 74 years

No previous CRC screening

Under-screened – defined as no FOBT screening within the last two years and/or no colonoscopy or barium enema screening within the last five years

No previous history of bowel cancer

Willing to provide consent to participate in the study

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Randomization

Eligible patients of participating PCPs randomized into an experimental (immediate intervention) group or to a control (delayed intervention) group

Control group receives “treatment as usual” health care and offered the intervention 6-10 months after the experimental group

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Patient Participant Recruitment

Immediate intervention groups are sent a letter of invitation via mail

Interested patients call the Research Department to book an appointment with the Patient Navigator

Follow up telephone calls are made to patients who have not responded within 2 weeks

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Patient Options: Book an in-office appointment with Navigator

Book a telephone appointment with Navigator

Complete survey only

Decline any participation in study

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Optional SurveyPurpose of survey is to capture patient “perception”

or “understanding” of CRC and screening options

Patient can choose to have survey mailed to their home with a postage paid return envelope

Patients who attend an in-office visit are asked if they are willing to complete a survey prior to seeing the Patient Navigator Nurse

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Informed Consent If patient chooses an in-person meeting with the Patient

Navigator, signed consent is collected at that time.

If the patient opts for a telephone-based Navigator meeting, verbal consent is obtained over the phone and documented. A copy of the consent form (signed by the Patient Navigator) is sent to the patient for their records.

Consent is implied by the patient if he/she completes and returns the survey to the research office.

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Intervention Components

Patient Navigator provides education on CRC

Patient’s medical history is discussed and assessed

Patient’s CRC screening options are reviewed

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If Patient chooses:FOBT Navigator gives patient ColonCancerCheck kit with

instructions how to complete and submit itColonoscopy Navigator arranges procedure for patientFOBT and Colonoscopy Navigator provides kit and arranges procedureNone of the above Navigator thanks patient for their time

NOTE: The PCP is responsible for communicating screening results to the patients

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Electronic Study Chart

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Study Benefits Increased patient awareness of CRC and

screening options

Early detection = increased survival

Increased CRC screening rates for PCP practices

Minimal impact to PCP practices

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CRCS Project TeamCo-Investigators: Paul Ritvo, Ph.D., C.Psych., Scientist, Cancer Care Ontario Brian Mitchell, MD, FRCSC, Group Health Centre,

Algoma District Medical Group

Project Members (Clinical Research Dept): Pina Paluzzi, Patient Navigator / Research Nurse Joshua McColeman, Health Informatics Specialist Nancy Juby, Clinical Research Assistant Samantha Delhenty & Christine Askin, Students Sharon Cuddy, Administration

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Questions?