Jermy-Leigh B. Domingo, MPH;
JoAnn U. Tsark, MPH;
Kathryn L. Braun, DrPH
â€˜Imi Hale Native Hawaiian Cancer Network and University of Hawaiâ€˜i at MÄnoa, Office of Public Health Studies
This systematic review aimed to answer three questions about screening navigation in Federally Qualified Community Health Centers (FQHCs): 1) Which navigation activities increased colorectal cancer (CRC) screening prevalence? 2) What were the challenges to implementing these programs in FQHCs? 3) Which clinic protocols supported CRC screening completion?
Published studies set in FQHCs in the United States.
Between September and October 2014, PubMed MEDLINE, CINAHL, and PsychINFO were searched for peer-reviewed publications focused on screening navigation interventions in FQHCs with >50% ethnic minorities.
Eight studies were included in the final analysis. Maintaining an updated electronic medical records system and funding were challenges to implementing navigation in all FQHCs. Common navigation activities and strategies included:Â patient education, patient screening reminders, and motivation and support to complete screening. In interventions promoting fecal occult blood test (FOBT) screening, CRC screening prevalence increased when navigators provided ongoing barriers counseling and instructions to complete the FOBT. The number of CRC screening protocols implemented in the clinic appeared to influence screening completion.
Findings from this review suggest that FQHCs implementing colorectal cancer screening navigation programs should task navigators with providing patient education on FOBT use and barriers counseling to improve FOBT completion. FQHCs also should establish a system to maintain current patient contact information and establish multiple CRC screening protocols (e.g., patient reminder system, standing orders for CRC screening) to enhance increased screening and surveillance. Also, navigation skills can be applied beyond CRC screening to provide outreach, education, screening reminders and support to patients for other recommended cancer screenings. Future research should assess the cost-effectiveness and patient satisfaction with navigation programs and their capacity to implement evidence-based interventions to increase cancer screening in FQHCs. With the advent of healthcare reform and movement toward patient-centered care models, patient navigation will be integral to FQHCs and their medically underserved clients.