Colorectal Cancer Screening Navigation for the Underserved: Experience of an Urban Program

Colorectal cancer is the third leading cause of cancer deaths in the United States. Although colorectal cancer screenings are effective and recommended by all clinical practice guidelines, only 65.7% of adults ages 50 to 75 years are screened. Colorectal cancer screening is disproportionately underutilized in inner city populations. In 2011, the University of Pennsylvania Health System created a navigation program to specifically address poor colorectal cancer screening rates and increase access to colorectal cancer screening colonoscopies for patients in the underserved areas of West, South, and Southwest Philadelphia. We directed focus on issues surrounding barriers of screening so that we could best leverage our resources and impact the greatest number of patients. The program was designed to target patients who were either due for, never scheduled, or did not keep previously scheduled colorectal cancer screening colonoscopy appointments, or who were referred by providers concerned that the patients would not keep appointments or would misunderstand preprocedural guidelines. The program strives to improve colorectal health by providing free education and screening navigation through a navigator who assists patients from the first phone call to completion of the colonoscopy. This is accomplished by implementing an effective screening program while providing one-on-one service with a cost-effective navigator reaching out to patients who are nonadherent to colorectal cancer screening. Barriers included not having a companion to escort and transport the patient home from the procedure, poor awareness, fear of the procedure or sedation, limited funds to purchase preparation materials, inability to read or comprehend preparation instructions, and hardship in being contacted or scheduling appointments.