Cristina Villagra

Understanding the Barriers and Facilitators of Colorectal Cancer Screening Among Low Income Immigrant Hispanics

Colorectal cancer (CRC) screening rates are low among Hispanics; thus understanding screening barriers and facilitators is essential. A survey, based on blended health promotion theories, was conducted with low income, mostly immigrant, Hispanics at community based organizations and health clinics in New York City. Correlates of undergoing colonoscopy screening were examined. Four hundred men (28%) and women were interviewed. Older age, longer US residence, having a regular health care provider and provider recommendation predicted colonoscopy receipt (P values <0.01). Greater fear and worry concerning colonoscopy and fewer perceived screening benefits were associated with reduced screening likelihood (P values <0.05). In a multivariate model, colonoscopy receipt was negatively associated with Medicaid and positively associated with English preference, physician recommendation for and encouragement of screening and less fear. Interventions that educate physicians and patients regarding colonoscopy screening guidelines, increase physicians’ screening referrals, and reduce patients’ fear are needed.

Training Experiences of Lay and Professional Patient Navigators for Colorectal Cancer Screening

Patient navigation (PN) is increasingly used in cancer care, but little is known about the identification and training of patient navigators. PN may be implemented by professional health care providers, paraprofessionals, or lay health workers and, therefore, presents an opportunity to compare professional and lay interventionist experiences. The goal of the current report is to compare the training experiences of four professional (Pro) and five lay (LHW) patient navigators enlisted to increase colonoscopy adherence among African American primary care patients. The results of early assessments showed that LHWs’ intervention-related knowledge was significantly lower than that of Pros. However, there were no significant differences in knowledge scores between LHWs and Pros for most subsets of knowledge items in later assessments. Furthermore, there were no significant differences in LHWs’ and Pros’ reported self-efficacy and satisfaction with training. Findings support the use of diverse strategies to train and prepare LHWs as patient navigators.

Colorectal Cancer Screening Brochure for Latinos: Focus Group Evaluation

Colorectal cancer (CRC) can be effectively prevented via screening colonoscopy, yet adherence rates remain low among Latinos. Interventions targeting individual and cultural barriers to screening are needed. We developed an educational brochure to target these barriers faced by a diverse Latino population. The objective was to evaluate the responses of the target population to the culturally and theoretically informed brochure through community member focus groups. Facilitators conducted six focus groups, stratified by gender, language, and prior colonoscopy experience. Topics included: brochure content and layout, cancer knowledge, and CRC screening determinants. Focus groups documented community members’ responses to the brochure’s overall message and its informational and visual components. Changes to wording, visual aids, and content were suggested to make the brochure culturally more acceptable. Results indicated relevance of the theoretically and culturally guided approach to the development of the brochure leading to refinement of its content and design.

Increasing referral rate for screening colonoscopy through patient education and activation at a primary care clinic in New York City

OBJECTIVE Colorectal cancer could be prevented through regular screening. Individuals age 50 and older are recommended to get screened via colonoscopy. Because physician referral is a major predictor of colonoscopy completion, two low-cost, evidence-based interventions were tested to increase referrals by activating patients to self-advocate. METHODS This study compared the impact of a pre-visit educational handout that prompts patients to discuss colonoscopy with their physician with the handout plus brief counseling through exit interviews and chart reviews. The main outcome was physician referral. RESULTS Medical charts were reviewed for eligibility: 130 control patients (Arm 1), 45 patients who received the educational handout and health counseling (Arm 2), and 50 patients who received only the handout (Arm 3). Colonoscopy referral rates increased from 24.6% in Arm 1 to 44.4% and 52.0% in Arms 2 and 3, respectively (p=0.001). The proportion of exit interview participants who discussed colonoscopy with their doctor increased from 68.8% in Arm 1 to 76.5% and 88.9% in Arms 2 and 3, respectively. CONCLUSIONS Results indicate that both interventions are effective at increasing colonoscopy referrals. PRACTICAL IMPLICATIONS Results suggest that an educational handout alone is sufficient in prompting patient-initiated discussions about colonoscopy.

Adenoma Prevalence and Distribution Among US Latino Subgroups Undergoing Screening Colonoscopy

BackgroundColorectal cancer (CRC) is the second leading malignancy diagnosed among US Latinos. Latinos in the USA represent a heterogeneous amalgam of subgroups varying in genetic background, culture, and socioeconomic status. Little is known about the frequency of CRC precursor lesions found at screening colonoscopy among Latino subgroups.AimThe aim was to determine the prevalence and distribution of histologically confirmed adenomas found at screening colonoscopy among average-risk, asymptomatic US Latinos according to their subgroup and socio-demographic background.MethodsCross-sectional analysis of pathological findings resulting from screening colonoscopy among average-risk, asymptomatic US Latinos aged ≥50 in two prospective randomized controlled trials at an academic medical center.ResultsAmong the 561 Latinos who completed screening colonoscopy, the two largest subgroups were Puerto Ricans and Dominicans. The findings among both subgroups were: adenomas 30.6%, proximal adenomas 23.5%, advanced adenomas 12.0%, and proximal advanced adenomas 8.9%. These rates are at least as high as those found at screening colonoscopy among US whites. While Puerto Ricans were more likely than Dominicans to be born in the USA, speak English, be acculturated, have a smoking history, and be obese, there were no significant differences in adenoma rates between these subgroups.ConclusionsThe prevalence of adenomas, advanced adenomas, and proximal neoplasia was high among both subgroups. These findings have implications for CRC screening and surveillance among the increasingly growing Latino population in the USA.

Narrative Message Targets Within the Decision-Making Process to Undergo Screening Colonoscopy Among Latinos: a Qualitative Study

Colorectal cancer (CRC) is a preventable yet leading cause of cancer mortality among Latinos in the USA. Cultural targeting and narrative messaging are two strategies to increase the low screening colonoscopy rates among Latinos. This study identifies key messages for educational interventions aiming to increase screening colonoscopy used among Latinos and proposes a model to understand the relationship between factors involved in colonoscopy decision-making. Individual in-depth interviews were conducted with 12 Latino participants primarily of Puerto Rican descent on the topics of CRC knowledge, barriers and facilitators to colonoscopy use, and the use of narrative in colorectal health messaging. Knowledge about colorectal anatomy and the anesthesia component of colonoscopy procedure is low. Fear of procedure-related pain and fear of treatment-related burden following a cancer diagnosis are significant barriers to colonoscopy. Fear of disease-related suffering and death following a cancer diagnosis and fear of regret are strong facilitators and can be augmented by cancer narratives. Storytelling is commonly used in Latino culture and is an acceptable method to educate the Latino community about CRC screening via colonoscopy. Machismo is a unique barrier to colonoscopy for Latino men via homophobia and reluctance to seek healthcare. A preliminary model to understand factors in colonoscopy decision-making among Latinos is presented. Counseling practices and educational interventions that use culturally targeted narrative health messaging to mediate fears and increase colonoscopy knowledge may increase screening colonoscopy use among Latinos.

Adaptation of a Cancer Clinical Trials Education Program for African American and Latina/o Community Members

The pilot study reported in this article culturally and linguistically adapted an educational intervention to promote cancer clinical trials (CCTs) participation among Latinas/os and African Americans. The single-session slide presentation with embedded videos, originally developed through a campus–community partnership in Southern California, was chosen for adaptation because it was perceived to fit the CORRECT model of innovation (credible, observable, relevant, relatively advantageous, easy to understand, compatible, and testable) and because of the potential to customize any components not identified as core, allowing them to be revised for cultural and linguistic alignment in New York City. Most of the 143 community participants (76.2%) were female; most (54.6%) were older than 59 years. More than half (78.3%) preferred to speak English or were bilingual in English and Spanish. A large proportion (41.3%) had not completed high school. Knowledge and perceived benefits and barriers regarding CCT showed small, though statistically significant, increases. There were no statistically significant group differences for changes in mean knowledge, perceived benefits, or perceived barriers when examined by ethnicity, education level, language, or other included sociodemographic variables. However, a small, but statistically significant difference in perceived barriers was observed when examined by country of origin, with the foreign born score worsening 0.08 points (SD = 0.47, p = .007) on the 5-point Likert-type scale administered posteducation compared to preeducation. Participants’ open-ended comments demonstrated the acceptability of the topic and intervention. This adaptation resulted in an intervention with the potential to educate African American and Latina/o general community members in a new geographic region about the purpose, methods, and benefits of CCTs.

Abstract B76: Optimism and barriers to colonoscopy in low-income Latinos at average risk for colorectal cancer

Purpose: Colorectal cancer (CRC) can be prevented and treated effectively when detected early, especially via colonoscopy. However, only 39% of CRC cases in the United States are detected early. CRC screening continues to be underutilized particularly by Latinos, the largest minority group in the U.S. As colonoscopy is considered by many to be the gold standard for screening, it is important to reduce barriers to colonoscopy screening, particularly among Latinos, and then develop targeted interventions to increase colonoscopy screening. One identified barrier to colonoscopy screening is CRC related distress as measured by fear and worry about colonoscopy. The purpose of this study is to explore how optimistic and fatalistic beliefs relate to fear and worry about CRC and screening colonoscopy. If these relationships are better understood, we can attempt to alleviate CRC-related distress by developing, or revising, culturally targeted health education interventions to reduce fatalistic beliefs and promote optimism about colonoscopy screening in Latino population. Such intervention, in turn, could lead to increased colonoscopy screening in this underserved population. Procedures: Baseline data from the first 100 participants of an IRB approved intervention study to increase colonoscopy screening among Latinos was collected via in-person interview. Eligibility criteria included: 1) self-identified Latino; 2) ages 50-85; 3) no personal or family history of CRC below age 60; 4) no history of gastrointestinal disorder; 5) no colonoscopy procedure in the last 5 years; 6) referral for screening colonoscopy by Primary Care Provider; and 7) English or Spanish speaker. Sociodemographic, medical, and psychosocial data were collected. Psychosocial measures included: 1) optimism (Life Orientation Test – Revised (LOT-R)); 2) worry (a 3 item measure developed by Vernon et al.); 3) fatalism (a 5 item abbreviated version of Powe9s fatalism measure); 4) and fear (a 6-item measure used in our prior research). Results: Greater optimism, lower fatalism, and an absence of family history of cancer were associated with decreased CRC worry (p Conclusions: Optimism appears to have a negative relationship with both components of distress: fear and worry; while fatalism is only positively correlated with worry but not fear. In addition, individuals with family history of any cancer type experience greater CRC distress. Interventions that promote optimistic beliefs may be able to reduce both level of fear and worry among Latinos referred for colonoscopy and potentially have a positive effect on screening outcomes. Citation Format: Elizaveta Efuni, Lina Jandorf, Cristina Villagra, Gary Winkel, Tatiana Starr, Katherine N. DuHamel. Optimism and barriers to colonoscopy in low-income Latinos at average risk for colorectal cancer. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B76. doi:10.1158/1538-7755.DISP13-B76