GROUP HEALTH CENTRE

1. Increasing Colorectal Cancer Screening Uptake with a Patient NavigatorDr. Brian Mitchell, Co-InvestigatorNorthern Ontario Health Research ConferenceSudbury, ONJune 4-5, 2010

2. GROUP HEALTH CENTRE Ontario’s largest and longest established ambulatory health care organization providing excellence in health care to over half the population of Sault Ste. Marie for 47 years.

3. Unique health organization 54,000 patients on our roster Not-for-profit Multi-disciplinary Multi-specialty Multi-site 61 Physician providers 9 Nurse Practitioners 180 other health care professionals Electronic Medical Record since 1997 PATIENT-FOCUSED TEAM

4. Group Health Centre is the health care partnership of theSault Ste. Marie and District Group Health Associationand theAlgoma District Medical Group.The two groups are linked together by a common objective – to provide excellent, innovative, and comprehensive health care to meet the needs of the community.

5. Colorectal Cancer (CRC) Facts • 2nd deadliest cancer in Canada • 2nd leading cause of cancer-related death in both men and women • Ontario has one of the highest rates of CRC in the world • CRC is highly preventable -- 90% curable if detected in early stages Ministry of Health and Longterm Care. (2010). ColonCancerCheck. What is Colon Cancer?www.health.gov.on.ca.

6. Research Question: Does tailored navigation provided by a registered nurse increase the number of participants who undergo screening for colorectal cancer?

7. Study Design • 2 year randomized intervention trial • Experimental and control (delayed intervention) groups • Recruitment from participating Primary Care Provider practices located at GHC • Part of a series of investigations undertaken by the Canadian Institute for Health Research (CIHR) Emerging Team in Colorectal Cancer Screening, led by Linda Rabeneck, BSc, MD, MPH, FRCPC

8. What is a Patient Navigator? • A trained health care professional who assumes responsibility for helping individuals through the process of care • Study role is to assist eligible patients to navigate the various screening options and decide which preferred option to act on

9. PCP Recruitment Primary Care Providers (PCPs) located at GHC were invited to include their patient practice roster as potential participants in the study • PCPs received a letter of invitation that outlined the study objectives and the randomization process • Study nurse visited PCP offices and provided a list of their unscreened and under-screened patients • PCPs agreed to sign a recruitment letter that would be sent to their patients

10. Eligible Participants • Men and women age 50 – 74 years • No previous CRC screening • Under-screened – defined as no FOBT screening within the last two years and/or no colonoscopy or barium enema screening within the last five years • No previous history of bowel cancer • Willing to provide consent to participate in the study

11. Randomization • Eligible patients of participating PCPs randomized into an experimental (immediate intervention) group or to a control (delayed intervention) group • Control group receives “treatment as usual” health care and offered the intervention 6-10 months after the experimental group

12. Patient Participant Recruitment • Immediate intervention groups are sent a letter of invitation via mail • Interested patients call the Research Department to book an appointment with the Patient Navigator • Follow up telephone calls are made to patients who have not responded within 2 weeks

13. Patient Options: • Book an in-office appointment with Navigator • Book a telephone appointment with Navigator • Complete survey only • Decline any participation in study

14. Optional Survey Purpose of survey is to capture patient “perception” or “understanding” of CRC and screening options • Patient can choose to have survey mailed to their home with a postage paid return envelope • Patients who attend an in-office visit are asked if they are willing to complete a survey prior to seeing the Patient Navigator Nurse

15. Informed Consent • If patient chooses an in-person meeting with the Patient Navigator, signed consent is collected at that time. • If the patient opts for a telephone-based Navigator meeting, verbal consent is obtained over the phone and documented. A copy of the consent form (signed by the Patient Navigator) is sent to the patient for their records. • Consent is implied by the patient if he/she completes and returns the survey to the research office.

16. Intervention Components • Patient Navigator provides education on CRC • Patient’s medical history is discussed and assessed • Patient’s CRC screening options are reviewed

17. If Patient chooses: FOBT  Navigator gives patient ColonCancerCheck kit with instructions how to complete and submit it Colonoscopy  Navigator arranges procedure for patient FOBT and Colonoscopy  Navigator provides kit and arranges procedure None of the above  Navigator thanks patient for their time NOTE: The PCP is responsible for communicating screening results to the patients

18. Electronic Study Chart

19. Study Benefits • Increased patient awareness of CRC and screening options • Early detection = increased survival • Increased CRC screening rates for PCP practices • Minimal impact to PCP practices

20. CRCS Project Team Co-Investigators: Paul Ritvo, Ph.D., C.Psych., Scientist, Cancer Care Ontario Brian Mitchell, MD, FRCSC, Group Health Centre, Algoma District Medical Group Project Members (Clinical Research Dept): Pina Paluzzi, Patient Navigator / Research Nurse Joshua McColeman, Health Informatics Specialist Nancy Juby, Clinical Research Assistant Samantha Delhenty & Christine Askin, Students Sharon Cuddy, Administration

21. Questions?