For many people, feeling healthy is reason enough to put off scheduling a preventive exam, even when it’s doctors orders. For others, a busy schedule often gets in the way and there’s just no time. Still other patients put off exams because of cultural and socioeconomic barriers. Some patients, for example, experience financial constraints, language barriers, transportation needs, conflicts with work, and child or elder care demands that make it difficult or impossible to follow through the process of having a screening test. Regardless of the reasons for putting them off, screening tests are vital to everyday health and can prevent sickness or even death.
“Colorectal Cancer Screening (CRCS) has been proven to be an effective means for CRC control and prevention, yet CRC screening rates remain poor. Despite being preventable, CRC continues to kill a disproportionate number of African Americans each year,” said Carmen Guerra MD, MSCE, associate professor in the Department of Medicine at the Hospital of the University of Pennsylvania. “When we have the means to prevent just about every case of colorectal cancer through screening colonoscopy, these deaths are senseless and the racial disparity is a social injustice. Each one of those cases is a painful case of cancer for someone's husband, wife, mother, father, son, or daughter.”
Carmen E. Guerra MD, MSCE, Michael L. Kochman, MD, FACP, Alicia Lamanna, Medical Assistant and patient liaison for the program and Josh Ramos, a Penn junior who was awarded a grant to work on the navigation project.
Together with the Wilmott Professor of Medicine, Michael Kochman, MD, FACP, Guerra is launching Penn Medicine and the Abramson Cancer Center’s West Philadelphia Gastrointestinal (GI) Health Outreach and Access Program, a patient navigation program that aims to improve the colorectal cancer screening rates for the residents of West Philadelphia by providing guidance and assistance every step of the way. They’ll help patients better understand the preparation process that comes before the screening, and provide assistance for transportation to and from the procedure, and financial assistance covering the costs. A patient navigator is a trained health care professional who works on behalf of the patient to identify and overcome potential barriers to obtaining a screening test. Patient navigators guide patients through the health care system to ensure completion of the screening test, and make sure that patients receive information that is matched to their level of health literacy. Originally developed to address racial and socioeconomic disparities in breast cancer outcomes, studies demonstrate that patient navigation programs can successfully increase colonoscopy screening rates among urban minorities. Other studies show that patients who receive navigation services report greater patient satisfaction.
One of the first navigator programs of its kind in the country, the West Philadelphia GI Health Outreach and Access Program helps identify and address patient barriers to completing colorectal cancer screening. Navigators will assist with scheduling the colonoscopy, and educating the patient about what is needed to prepare for and complete the procedure. With financial support from a grant from the American Cancer Society and the Walmart Foundation, navigators will also provide the items patients must take to prepare their body for the procedure - Miralax and Crystal Lite - free of charge for patients who are unable to afford the costs of the prep, and Septa tokens (or other means of transportation) for those who otherwise cannot get to and from the hospital.
Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States, but since colonoscopies remove pre-cancercous polyps, the test itself actually plays a role in preventing the disease from happening in the first place. Despite the possibility of early detection, the American Cancer Society says that compared to white Americans, African Americans are 20 percent more likely to suffer from colorectal cancer, and are almost 50 percent more likely to die from the illness. With an estimated 76.6 percent of the residents in West Philadelphia being black or African American, the disparity in colorectal cancer is a problem that is literally close to home.
Program leaders are currently working with civic leaders and community organizations throughout West Philadelphia, and community members and medical providers have agreed to assist in educating patients eligible for the exam on the importance of screening and refer these patients to the new West Philly GI Program. “This is a great display of collaborative community spirit,” noted Kochman. “Working with our partners and community groups is just going to help us reach more people who need help understanding the screening test process or in making arrangements so they can get to and from the hospital.”
“Navigation programs are evidence-based interventions that reduce or eliminate racial and socioeconomic disparities in health care outcomes,” said Guerra. “I wanted to help apply that research here at UPHS, so that we might help the residents of West Philadelphia access colorectal cancer screening and thereby reduce the rates of colorectal cancer in our own community.”