the primary care excellence model increasing colorectal cancer screening uptake with a patient...
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The primary care excellence model
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 it
Colonoscopy Navigator arranges procedure for patient
FOBT and Colonoscopy Navigator provides kit and arranges procedure
None 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?