Tuesday, March 1, 2011

Breaking Barriers

How an innovative Colorectal Cancer Screening Navigator Program is reducing disparities in screening rates.

Dr. Del Carmen

Patient Navigators

(from left to right):Diana Maldonado, Cervical Cancer Navigator; Yasmine Hung, Avon Breast Cancer Navigator; Gloria Gamba and Rade Boskovic (not pictured), Colon Cancer Navigators

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His doctor told him he was overdue for a routine colonoscopy, but the 53 year-old man from El Salvador was nervous. He knew the procedure would require time away from work, which was difficult to arrange. Language barriers made the extensive preparation and the test itself very confusing. He could have easily slipped through the cracks and avoided the test. Instead, a dedicated patient navigator called him to follow up. She talked him through the prep and the procedure – in Spanish – and discussed his fears and scheduling difficulties. She helped arrange a convenient appointment, and even accompanied him to show her support. During his colonoscopy, two pre-cancerous polyps were removed; the procedure he nearly missed may have saved his life.

Stories like this are increasingly common at the Mass General Chelsea Healthcare Center, thanks to an innovative Colorectal Cancer Screening Navigator Program, developed by the Mass General Hospital Center for Community Health Improvement (CCHI) in collaboration with the Mass General Cancer Center. The initiative, funded by philanthropy, was designed to increase colonoscopy completion rates while reducing healthcare disparities for Latino patients and other underserved populations.

Addressing a Community Need

“We conducted research that indicated that four types of cancer — colorectal, cervical, breast and lung — are more common and/or more deadly in our health center communities than in the rest of the state,” says Joan Quinlan, executive director of the CCHI. “Thanks to the commitment of Bruce Chabner, MD, to ensuring all Mass General patients have equal access to quality cancer care and prevention, we created a vision and plan for reducing these disparities.”

Language difficulties, cultural differences, scheduling and transportation problems, and a lack of patient education can prevent patients from getting the tests and procedures they need to prevent and treat cancer.

“Pairing underserved patients with bilingual, culturally fluent patient navigators is an incredibly effective way to ensure that patients get the screening and follow up care that they need,” says Sarah Oo, MSW, director of Community Health Improvement at the Mass General Chelsea HealthCare Center. “These individuals live complex and challenging lives, and the support they receive from patient navigators empowers them to prioritize their health in a way that is comfortable and appropriate to their culture and circumstances.”

A Hands-On Approach

The patient navigators in the Colorectal Cancer Screening Program take a hands-on approach. They identify patient-perceived barriers to screening and individually tailor their interventions. Navigators educate, motivate, schedule and remind patients about their appointments, arrange transportation and connect those in need with financial counseling. Navigators often even accompany patients to appointments. Their dedication pays off; in 2010 alone the two navigators arranged 156 colonoscopies, and polyps were removed during about one-third of these appointments.

“In its first year, the Colorectal Cancer Screening Navigator Program doubled the screening rate among our patients,” explains Sanja Percac-Lima, MD, PhD, the CCHI’s physician leader for cancer outreach programs. “We’ve grown from a pilot project funded by a single Clinical Innovation Award, to a successful program that can serve as a model for similar outreach efforts, through Mass General’s dedication and generous donor support.”

Disparities in access to health care and in cancer-related incidence and mortality continue to plague our communities and our health care system. The Mass General Cancer Center strives, with the help of its generous donors, to address and overcome these differences through scientifically based interventions designed to improve the health of individuals, communities and the country. Community health initiatives like the Colorectal Cancer Screening Navigator Program offer hope for the future and provide a template for success.

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