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How barbershops help NYU Langone boost cancer screening rates

August 30, 2017

    Colorectal cancer screening rates are increasing and incidence is decreasing in the United States, which is certainly good news.

    The bad news: Some groups are still disproportionately affected by colorectal cancer. According to the CDC, black men have the highest colorectal cancer incidence and death rate among all racial groups. This is driven in large part by the fact that they're less likely to be insured and have a personal doctor compared to other populations, leading to lower rates of screening and early-stage diagnosis when the disease is most treatable.

    That's why researchers in the Department of Population Health at NYU Langone Health brought colorectal cancer screening to their local communities. Keep reading to find out how they succeeded in increasing screening rates for black men.

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    Community health workers recruited black men from barbershops in New York City

    Researchers conducted a randomized control trial to test the effectiveness of a telephone-based patient navigation intervention in increasing colorectal cancer screening rates among black men. To reach this population, community health workers recruited participants from New York City barbershops—which are safe spaces and cornerstones of many black communities. They targeted English-speaking men aged 50 or older who were not up-to-date on their colorectal cancer screening, had uncontrolled high blood pressure, and had a working telephone.

    Of the more than 4,000 men screened across 111 barbershops, researchers identified 731 eligible men and randomly assigned them to receive one of three interventions:

    1. Patient navigation by a community health worker for colorectal cancer screening;
    2. Motivational interviewing for blood pressure control by a trained counselor, which served as the control group; or
    3. Patient navigation by a community health worker for colorectal cancer screening AND motivational interviewing for blood pressure control by a trained counselor

    Patient navigators help men address barriers to colorectal cancer screening

    In the patient navigation groups, community health workers educated men about colorectal cancer screening; assessed their readiness and potential logistic and psychosocial barriers (e.g., lack of insurance, lack of knowledge about screening locations) for screening; and encouraged them to make a screening appointment within two weeks.

    Navigators mailed fecal immunochemical test (FIT) kits and instructions to participants interested in FIT screening. They followed up with the men via phone within two weeks of the initial meeting to see whether they had been screened. If they hadn't received a screening yet, navigators reached out periodically across the next six months to encourage them to do so and provide any necessary support.

    In the motivational interviewing for blood pressure control group, men were educated about self-managing blood pressure and colorectal cancer screening and participated in motivational interviewing-driven goal setting during their initial session. They also had three additional sessions with counselors to follow up on their progress against their blood pressure management goals and refine them as necessary.

    In the third group, participants received both interventions concurrently.

    Men who received navigation were twice as likely to get screened

    At the end of the six-month study period, 17.5% of men in the patient navigation-only group and 17.8% of men in the patient navigation and motivational interviewing group had received a colorectal cancer screening. In contrast, only 8.4% of the men in the control group (motivational interviewing only) were screened for colorectal cancer during the same timeframe.

    The bottom line: Focus on promoting cancer screening in community settings

    The key takeaway for health care systems is that patient navigation programs initiated in a community-based setting, rather than a clinical setting, can be effectively leveraged to increase cancer screening, especially among hard-to-reach populations. Whether it be barbershops, churches, or other community organization, it's critical for cancer programs to develop partnerships and provide education to their communities.

    Get best practices on making the most of your navigation program

    Watch our webinar, Cancer Patient Navigation to learn how three organizations have developed best-in-class cancer patient navigation programs. We'll also provide an overview of our Navigation Toolkit to help guide the development or redesign of your navigation program.


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