Navigators Ease Colonoscopy Jitters in Men

Study found University Health pilot program aimed at Hispanic men cost-effective

No one looks forward to a colonoscopy with much enthusiasm. But for Hispanic men, it’s an even harder sell.

Far too few Hispanic men get recommended colon cancer screening tests — even though colorectal cancer is the second most common cause of cancer death in that population. And Hispanics are more likely to be diagnosed at an advanced stage of the disease, when it’s harder to treat.

For several years, University Health has studied the use of male, Spanish-speaking patient navigators to explain the benefits of colorectal screenings to Hispanic men enrolled in CareLink, a financial assistance program for low-income Bexar County residents, and to make it easier for them to schedule and undergo colonoscopies. The Health System also launched an awareness campaign aimed at Hispanic men.

Current recommendations call for everyone beginning at age 50 to have some form of regular screening for colon cancer.

A new study published in the Journal of Cancer Education found that the most comprehensive of these navigator programs at University Health not only convinced the vast majority of men to get a colon cancer test, but it was cost-effective too — even when the navigator visited the patient and his family at their home, allowed them to schedule the screening at their convenience, and provided transportation to the screening.

Carlos Cardenas, 67, found his resistance to the test melting after a home visit from a navigator three years ago.

“I was very reluctant to do it,” said Cardenas, a retired department store employee. “There was a gentleman who came to my house. He was very informative about the procedure. He opened my mind to it, and I agreed.”

The flexible scheduling and the transportation proved especially effective in this population, said Dr. Roberto Villarreal, senior vice president of research and information management at University Health, and lead investigator of the pilot project funded by the Cancer Prevention and Research Institute of Texas.

“They were often the only ones in the home who drive,” Dr. Villarreal said. “Many of them are roofers, plumbers, carpenters. For them to take one day off to have a colonoscopy, they have to have somebody take them.”

But the real secret weapon in getting the men to agree to colonoscopies was the decision to include their wives in the conversation, he added.

“When the navigator presented information to the man and his family, it was the wife who said: ‘You have to do it.’ The wife made the decisions,” Dr. Villarreal said.

Among the 370 men who underwent colonoscopies in the pilot project, 134 had polyps that were removed and tested. Five were diagnosed with colon cancer and referred to treatment.

And while the comprehensive navigator program cost about $498 per patient, the program led to a net health savings of $1,148 per patient — or almost $425,000 in total savings for 370 men who took part over a two-year period, a team of researchers from across the country estimated.

Currently, University Health is using a less comprehensive navigator program funded by the Delivery System Reform Incentive Payment Program, part of the Texas 1115 Medicaid waiver. That program does not include home visits and transportation. But the Health System is seeking new grant funds to continue and expand the comprehensive navigator program based on the success of the pilot, Dr. Villarreal said.

In addition to Dr. Villarreal, researchers from the Center for Health Innovation at the New York Academy of Medicine, the University of Nebraska College of Public Health, and the University of Pennsylvania Leonard Davis Institute of Health Economics were co-authors of the paper.