Dana-Farber is bringing fresh momentum to a community outreach program aimed at increasing colorectal cancer screening rates among racial and ethnic minority groups in the Boston area.
The program, dubbed Open Doors to Health, has trained residents of local low-income housing complexes to be "peer leaders" who help fellow residents reduce their risk for colorectal cancer and get screened for the disease at local hospitals.
In addition, a "patient navigator" aids residents in overcoming some of the obstacles to getting a colonoscopy exam, in which a doctor views the interior of the colon with a flexible scope.
The project expands an ongoing study that began in 2003 in 12 housing sites throughout Greater Boston.
Six of the sites initially had peer leaders, who supported residents in increasing their level of physical activity and helped build awareness of the importance of colorectal cancer screening, particularly among residents over age 50 and those with a family history of the disease.
The other six sites received pamphlets on the value of screening and physical activity, but didn't have peer leaders.
Residents of all the sites were given streamlined access to screening services, including those at Brigham and Women's Hospital (BWH). The study compares physical activity levels and colorectal cancer screening rates at the peer leader and information- only sites.
Although the results are still being analyzed, it's clear that "the peer leaders have had a very positive influence in their communities," says Karen Emmons, PhD, deputy director of Dana-Farber's Center for Community-Based Research and principal investigator on the Open Doors to Health project.
The expanded project includes training for peer leaders at the sites previously without them and the addition of a patient navigator to work closely with residents at all participating sites, as well as with patients at two community health centers in Boston's Jamaica Plain neighborhood.
Supported by the Dana-Farber/Brigham and Women's Cancer Center, the navigator promotes colon cancer screening and improves access to screening centers by helping people overcome common barriers to these services.
One such barrier, inadequate preparation for the procedure, is addressed by helping residents and patients understand the preparation instructions.
The navigator's role involves ensuring that residents have transportation to and from their appointments, meeting with them to allay their concerns about screenings, and working with hospital staff to coordinate follow-up services.
This approach can produce better outcomes for patients and reduce the costs associated with improper preparation and high no-show rates for colonoscopies.
"We've found that while pamphlets and peer leaders are helpful for encouraging people to schedule colorectal cancer screenings, many people fail to prepare properly or are unable to make their appointment because of transportation issues," says Wanda McClain, executive director of Community Health and Health Equity at BWH.
"There is evidence, both from research and other patient navigator programs, that navigators can increase screening rates in this population."
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