Approximately one out of every ten deaths in the United States is attributable to an underlying disease of the gastrointestinal system. Outpatient endoscopy constitutes an integral part of the care plan to diagnose and treat these disorders. In the last decade, endoscopic screening for detection of premalignant lesions has been increasing. Underserved populations have a disproportionally higher burden from gastrointestinal diseases that are commonly prevented, diagnosed or treated with endoscopy such as peptic ulcer disease due to higher prevalence of Helicobacter Pylori infection and colorectal cancer. Unfortunately, a high rate of non- compliance to outpatient endoscopy has been reported among underserved populations particularly in safety net hospitals. Patient navigation services have been shown to improve adherence, but the added manpower cost has prevented this strategy from being routine in most minority serving institutions. Therefore, there is a need for a readily available and low cost alternative to improve endoscopy delivery among the underserved. We observed that married patients were more compliant with cancer screening whether there is a need for escort (colonoscopy) or not (mammography). Therefore, we hypothesize that directly involving the patient's social contact person will improve compliance to out-patient endoscopy in terms of showing up for their procedures and following preparation instructions. No previous study has evaluated the direct involvement of a patient's social contact to improve endoscopy services delivery. We plan to recruit 400 patients who have been scheduled for out-patient screening colonoscopy and randomly assign them into two groups stratified by marital status (married versus unmarried): In usual care (group 1), only the patient will be given a telephone reminder 3 days before their scheduled procedures. In the intervention arm (group 2), the patient will be reminded as in usual care, but the social contact will also be contacted and asked to assume the role of a patient navigator to encourage the patient and facilitate his/her completion of the scheduled colonoscopy. We will compare the percentage of patients who show up for their colonoscopy and also compare the quality of the procedure performed as measured by the adequacy of bowel preparation.
The use of patient navigators hired by healthcare institutions has been reported to increase compliance to colon cancer screening with colonoscopy among underserved populations. The proposed project seeks to determine whether a direct involvement of a patient's social contact person as a facilitator (to function like a patient navigator) is acceptable to patients, and can also increase compliance to scheduled out-patient screening colonoscopy among an underserved inner city population. This will provide a relatively inexpensive and readily available intervention to improve endoscopy delivery to the underserved.
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