Aging Black men are at much greater risk of dying prematurely of colorectal cancer than any other group in the United States, and they are less likely than their white counterparts to be diagnosed at an early stage of the disease. Now a new study finds that patients who participated in a patient navigator program in which they enrolled at their barbershops were twice as likely to get screened for colorectal cancer.
The new clinical trial was led by the Department of Population Health at NYU Langone Health, and published recently in the American Journal of Public Health. It is the first, say the authors, to evaluate patient navigation—in which health care staff guide patients toward colorectal cancer screening in a timely fashion—in a true community setting.
Unlike the newly published MISTER B study (the Multi-intervention Study to Improve Colorectal Cancer Screening and to Enhance Risk Reduction in Black men), most prior studies of programs that link Black men to patient navigators to prevent colorectal cancer have based themselves at clinics. Specifically, the researchers found that participants who received help from the navigators in MISTER B were twice as likely to get screened as those who did not receive a patient navigator.
“Black men are less likely than the general population to be insured and to have a personal doctor, which is why we went beyond the clinic and to the community,” said Joseph Ravenell, M.D., M.P.H., the principal investigator of the study and associate professor in the Department of Population Health at NYU Langone’s Center for Healthful Behavior Change. “Barbershops in particular hold special appeal for community-based intervention trials, are popular forums for open conversation and could be leveraged to lessen the death rate from colorectal cancer in Black men.”
How the MISTER B study was conducted
From late 2009 to late 2013, community health workers visited 111 interested barbershops in all five boroughs of New York City, screening 4,025 Black male customers or nearby residents aged 50 or older for eligibility based on whether they were up-to-date for colorectal screening. The study then enrolled 731 men in one of three groups.
The first group was paired with a patient navigator who would help them address barriers to setting up a colorectal screening. These barriers included a lack of insurance coverage and a lack of knowledge about the need for screening, available options and screening locations. The second group, which was the control group, received motivational interviewing intervention for blood pressure control by a trained counselor, and the third group received both interventions.
Researchers then reviewed health education materials published by the American Cancer Society addressing colorectal cancer screening and the National Heart, Lung, and Blood Institute on high blood pressure self-management with all participants.
Those randomized to the patient navigation intervention received follow-up phone calls from patient navigators within two weeks and periodically over the course of six months to help them schedule a colonoscopy, or choose another type of screening for colorectal cancer. Participants who preferred fecal immunochemical test screening were sent a kit and instructions by mail, and received follow-up calls from the navigator to confirm the testing.