Stakeholder Perspectives on Colonoscopy Navigation and Colorectal Cancer Screening Inequities

Area of Science:

• Health Services Research
• Health Disparities
• Cancer Screening

Background:

• Black adults exhibit lower colonoscopy completion rates compared to other demographics, despite a higher risk of colorectal cancer.
• Patient navigation is a strategy to mitigate factors affecting colonoscopy completion, yet its role in reducing racial disparities in screening remains under-documented.

Purpose of the Study:

• To investigate how a statewide colonoscopy navigation program addressed challenges encountered by low-income Black adults seeking screening colonoscopies.
• To understand the multifaceted benefits of patient navigation from the perspectives of patients, navigators, and clinical staff.

Main Methods:

• A qualitative case study approach was employed at a clinical site within a statewide colonoscopy navigation program.
• Data collection involved clinical observations, document reviews, and semi-structured interviews with 31 patients, patient navigators, and clinical staff.
• Thematic coding was utilized to analyze patient experiences, perceptions, and emotions related to patient navigation and colonoscopy completion.

Main Results:

• Patients and navigators identified logistical, psychosocial, and knowledge-related barriers to colonoscopy completion.
• Clinical staff primarily reported logistical barriers but also noted improved relationships with referring specialty practices.
• Patient navigators effectively addressed patient-specific barriers often unrecognized by clinical staff, revealing varied stakeholder benefits.

Conclusions:

• Patient navigation programs are crucial for addressing the unique barriers faced by underserved populations in completing essential cancer screenings.
• The strategy offers distinct advantages to different stakeholders, enhancing patient care and improving healthcare system efficiencies.
• Understanding these varied benefits provides valuable insights into the successful implementation and broader appeal of patient navigation in reducing health disparities.