Evaluation of a patient navigation program to promote colorectal cancer screening in rural Georgia, USA


  • We acknowledge Dr. Michelle Kegler, Michelle Carvalho, Dr. James Hotz, Dr. Iris Smith, Dr. George Fredrick, Charles Greene, Aisha Viquez, Shavonda Thomas, Dr. Teri Stapleton, Wesley Garland, Jingqui Yang, Yao Shi, and Diane Fletcher for their input and assistance. We extend a sincere thank you to the health center directors and staff who supported this evaluation; without them, this study would not have been possible.



Colorectal cancer (CRC) is a leading cause of cancer death in the United States. Early detection through recommended screening has been shown to have favorable treatment outcomes, yet screening rates among the medically underserved and uninsured are low, particularly for rural and minority populations. This study evaluated the effectiveness of a patient navigation program that addresses individual and systemic barriers to CRC screening for patients at rural, federally qualified community health centers.


This quasiexperimental evaluation compared low-income patients at average risk for CRC (n = 809) from 4 intervention clinics and 9 comparison clinics. We abstracted medical chart data on patient demographics, CRC history and risk factors, and CRC screening referrals and examinations. Outcomes of interest were colonoscopy referral and examination during the study period and being compliant with recommended screening guidelines at the end of the study period. We conducted multilevel logistic analyses to evaluate the program's effectiveness.


Patients at intervention clinics were significantly more likely than patients at comparison clinics to undergo colonoscopy screening (35% versus 7%, odds ratio = 7.9, P < .01) and be guideline-compliant on at least one CRC screening test (43% versus 11%, odds ratio = 5.9, P < .001).


Patient navigation, delivered through the Community Cancer Screening Program, can be an effective approach to ensure that lifesaving, preventive health screenings are provided to low-income adults in a rural setting. Cancer 2013;119:3059—3066. © 2013 American Cancer Society.