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Research ArticleOriginal Research

Results of Nurse Navigator Follow-up After Positive Colorectal Cancer Screening Test: A Randomized Trial

Beverly B. Green, Melissa L. Anderson, Ching-Yun Wang, Sally W. Vernon, Jessica Chubak, Richard T. Meenan and Sharon Fuller
The Journal of the American Board of Family Medicine November 2014, 27 (6) 789-795; DOI: https://doi.org/10.3122/jabfm.2014.06.140125
Beverly B. Green
From the Group Health Cooperative and Group Health Research Institute, Seattle, WA (BBG, MLA, JC, SF); the Department of Epidemiology, University of Washington School of Public Health, Seattle (JC); the Fred Hutchinson Cancer Center, Seattle, WA (C-YW); the Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston (SWV); and the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RTM).
MD, MPH
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Melissa L. Anderson
From the Group Health Cooperative and Group Health Research Institute, Seattle, WA (BBG, MLA, JC, SF); the Department of Epidemiology, University of Washington School of Public Health, Seattle (JC); the Fred Hutchinson Cancer Center, Seattle, WA (C-YW); the Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston (SWV); and the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RTM).
MS
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Ching-Yun Wang
From the Group Health Cooperative and Group Health Research Institute, Seattle, WA (BBG, MLA, JC, SF); the Department of Epidemiology, University of Washington School of Public Health, Seattle (JC); the Fred Hutchinson Cancer Center, Seattle, WA (C-YW); the Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston (SWV); and the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RTM).
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Sally W. Vernon
From the Group Health Cooperative and Group Health Research Institute, Seattle, WA (BBG, MLA, JC, SF); the Department of Epidemiology, University of Washington School of Public Health, Seattle (JC); the Fred Hutchinson Cancer Center, Seattle, WA (C-YW); the Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston (SWV); and the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RTM).
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Jessica Chubak
From the Group Health Cooperative and Group Health Research Institute, Seattle, WA (BBG, MLA, JC, SF); the Department of Epidemiology, University of Washington School of Public Health, Seattle (JC); the Fred Hutchinson Cancer Center, Seattle, WA (C-YW); the Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston (SWV); and the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RTM).
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Richard T. Meenan
From the Group Health Cooperative and Group Health Research Institute, Seattle, WA (BBG, MLA, JC, SF); the Department of Epidemiology, University of Washington School of Public Health, Seattle (JC); the Fred Hutchinson Cancer Center, Seattle, WA (C-YW); the Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston (SWV); and the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RTM).
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Sharon Fuller
From the Group Health Cooperative and Group Health Research Institute, Seattle, WA (BBG, MLA, JC, SF); the Department of Epidemiology, University of Washington School of Public Health, Seattle (JC); the Fred Hutchinson Cancer Center, Seattle, WA (C-YW); the Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston (SWV); and the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RTM).
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    Figure 1.

    Consort diagram of the System of Support Trial study participants with a positive fecal occult blood test (FOBT) or flexible sigmoidoscopy (FS); SOS, Systems of Support to Increase Colorectal Cancer Screening Study.

Tables

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    Table 1. Baseline Characteristics by Randomization Group of System of Support Trial Study Participants With a Positive Fecal Occult Blood Test (FOBT) or Flexible Sigmoidoscopy (N = 140)
    CharacteristicsUsual Care (n = 70)Nurse Navigation (n = 70)
    Age at baseline (years)
        50–6454 (77)57 (81)
        65–7316 (23)13 (19)
    Female sex31 (44)33 (47)
    White, non-Hispanic ethnicity51 (73)55 (79)
    General health
        Excellent/very good41 (59)40 (57)
        Good21 (30)23 (33)
        Fair/poor8 (11)7 (10)
    Married or living with partner52 (74)44 (63)
    Highest education
        High school graduate, GED, or less17 (24)8 (11)
        Some college24 (34)22 (31)
        Bachelor's degree or higher29 (41)40 (57)
    Never been screened for CRC28 (40)27 (39)
    First-degree relative with CRC6 (9)2 (3)
    Type of positive study test
        FOBT59 (84)59 (84)
        Flexible sigmoidoscopy11 (16)11 (16)
    • Data are number (%).

    • CRC, colorectal cancer; GED, general educational development.

    • View popup
    Table 2. Receipt of Colonoscopy Within 6 Months After a Positive Fecal Occult Blood Test or Flexible Sigmoidoscopy, by Randomization Group
    Usual Care (n = 70)Nurse Navigation (n = 70)P Value
    Colonoscopy Follow-up Within 6 Months
        Patients completing follow-up (n)5664
        Percentage* (95% CI)80.8 (71.7–89.9)91.0 (84.1–97.8).10
        Relative risk* (95% CI)1.0 (referent)1.13 (0.97–1.28)
        Risk difference* (95% CI)Referent10.1 (−1.5 to 21.7)
    • ↵* Adjusted for age, sex, race, and education.

    • CI, confidence interval.

    • View popup
    Table 3. Reasons for No and Late Colonoscopies (>6 Months) After a Positive Fecal Occult Blood Test or Flexible Sigmoidoscopy Based on Electronic Health Record Audits and Nurse Navigator Entries into the Study Database*
    No ColonoscopyLate Colonoscopy (>6 Months)Events
    UC (n = 8)Navigation (n = 2)UC (n = 6)Navigation (n = 4)
    Refused31——4
    Repetitively canceled or missed appointments4—217
    Referred but no appointment until after 6 months——3—3
    Cost concerns1——12
    Procedure concerns——426
    Too busy or other priorities1—1—2
    Lost health insurance or changed coverage11——2
    Other health issues—1—23
    Totals10310629†
    • ↵* Participants could have more than one reason for not completing a colonoscopy or completing it late.

    • ↵† Number of reasons for either not completing a colonoscopy or completing it late.

    • UC, usual care.

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The Journal of the American Board of Family     Medicine: 27 (6)
The Journal of the American Board of Family Medicine
Vol. 27, Issue 6
November-December 2014
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Results of Nurse Navigator Follow-up After Positive Colorectal Cancer Screening Test: A Randomized Trial
Beverly B. Green, Melissa L. Anderson, Ching-Yun Wang, Sally W. Vernon, Jessica Chubak, Richard T. Meenan, Sharon Fuller
The Journal of the American Board of Family Medicine Nov 2014, 27 (6) 789-795; DOI: 10.3122/jabfm.2014.06.140125

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Results of Nurse Navigator Follow-up After Positive Colorectal Cancer Screening Test: A Randomized Trial
Beverly B. Green, Melissa L. Anderson, Ching-Yun Wang, Sally W. Vernon, Jessica Chubak, Richard T. Meenan, Sharon Fuller
The Journal of the American Board of Family Medicine Nov 2014, 27 (6) 789-795; DOI: 10.3122/jabfm.2014.06.140125
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