Studies show patient-centered messaging improves rates of Latino-based colorectal cancer screening

Trials test effectiveness of outreach based on patients’ preferences for timing and content of messages

Gloria Coronado, Ph.D.

Colorectal cancer is the second leading cause of cancer death among both men and women in the United States, and yet over 60% of deaths could be prevented each year through routine screening. Despite this, a third of adults are not up-to-date with their colorectal cancer screening and the numbers are markedly lower for certain underserved populations, including Latinos, the uninsured and recent immigrants.

Gloria Coronado, Ph.D., an investigator at the Kaiser Permanente Center for Health Research (CHR) in Portland, Oregon, has conducted several research studies on the prevention of colorectal cancer, particularly among Latino populations. Most recently she led a team of investigators on a large Participatory Research to Advance Colon Cancer Prevention (PROMPT) trial testing the effectiveness of outreach and messaging for mailed colorectal cancer screening programs among Latino patients at community health clinics.

The results of the PROMPT study, along with a companion study exploring the use of culturally relevant communications using Boot Camp Translation (BCT), appear in the May/June 2019 issue of the Journal of the American Board of Family Medicine. 

Compared with 60% of non-Latino white men and women, only 42% of Latino men are up to date with colorectal cancer screening guidelines. Coronado and her research team noted that a contributing factor to the low screening rate is the difficulty Latinos encounter in understanding health information and taking the steps for preventive health actions. “Language, literacy and cultural factors are critical to address if screening rates are to improve,” noted Coronado.

In these two side-by-side studies, researchers compared the effectiveness of automated and live prompts and reminders as part of a mailed fecal immunochemical test (FIT) outreach program at Latino-based health clinics operated by a large, Los Angeles-based community health center. They also evaluated the literature on colorectal cancer screening interventions among Latinos to characterize intervention components effective in increasing colorectal cancer screening and used Boot Camp Translation, a patient engagement approach in which complex medical information is translated into concepts, messages, and materials that are meaningful and engaging to targeted community members.

“Boot Camp Translation provides a novel way to work directly with patients early in the research process, ensuring that study messages and materials are not only relevant to participants, but also culturally relevant,” said Jamie H. Thompson, M.P.H., lead author on one of the studies. “This patient engagement approach honors the local and cultural aspects of a community within the context of evidence-based health care.”

Funded by the National Institutes of Health National Institute of Minority Health Disparities, the PROMPT pilot study included 1,767 adult participants, 50 to 75 years of age who were not up-to-date with the colorectal cancer screening recommendations of their Los Angeles area community health center. In addition to a mailed FIT kit, the participants were randomized to receive 1) a text message prompt and two automated phone call reminders; 2) up to three live call reminders or 3) a text message prompt, two automated call reminders and up to three live reminders.

Results show that nearly 1/3 of the participants completed a FIT within six months, with the completion rates higher in those adults who received live call reminders or the automated calls combined with live call reminders. Both outperformed automated calls alone.  

The study was designed based on patients’ preferences for the timing and content of messages obtained from Boot Camp Translation. These included personalized messages, such as using ‘I’ and ‘we’ statements, that stress the urgency of colorectal cancer screening and the importance of family, and that are delivered within 2-weeks of the FIT kit mailing.

To read the full article on the study “Patient-Refined Messaging for a Mailed Colorectal Cancer Screening Program: Findings from the PROMPT Study” visit: https://www.jabfm.org/content/32/3/318

To read the full article on the study “Developing Patient-Refined Messaging for a Mailed Colorectal Cancer Screening Program in a Latino-Based Community Health Center“ visit: https://www.jabfm.org/content/32/3/307

Coronado and her researchers hope these studies can offer guidance, recommendations and tools to help community health centers’ future efforts to improve the screening rates of their clients. “Our ultimate goal is to help community health centers, which are the largest providers of primary care to our most vulnerable and culturally diverse communities, increase the effectiveness of the reminders by ensuring they meet the specific needs of their clients,” said Coronado. “With such a large number of individuals receiving care in the safety-net setting, an improvement in CRC screening rates of even a few percentage points can have a major impact in terms of cancers detected and lives saved.”

In addition to her research on cancer prevention, Coronado has examined Latino parents’ acceptance of the HPV vaccine for girls, evaluated strategies for reducing pesticide exposure for children of farm workers, and developed innovative, culturally tailored programs for reducing diabetes and cancer risks among Latinos in a rural setting. She has collaborated broadly with Latino-serving community-based organizations both locally and nationally.

These studies were supported by the National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number U01MD010665.

In addition to Coronado and Thompson, additional researchers on the PROMPT study included Amanda F. Petrik, M.S.; Denis B. Nyongesa; and Michael C. Leo, Ph.D. from CHR; and Melissa Castillo, M.S.W.; Brittany Younger, M.S.W.; Anne Escaron, Ph.D.; and Alex Chen, M.D., from AltaMed Health Services in Commerce, CA.

Additional researchers on the BCT study included Jennifer S. Rivelli, M.A. and Sacha L. Reich, M.S. from CHR; Melinda M. Davis, Ph.D. and LeAnn Michaels from Oregon Health & Science University in Portland, OR; and Melissa Castillo, M.S.W.; Brittany Younger, M.S.W.;  Marta Castro; Anne Escaron, Ph.D.; and Alex Chen, M.D., from AltaMed Health Services in Commerce, CA.