1. The primary care excellence model Increasing Colorectal Cancer Screening Uptake with a Patient Navigator Dr. Brian Mitchell, Co-Investigator Northern Ontario Health Research Conference Sudbury, ON June 4-5, 2010

2. The primary care excellence model 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. The primary care excellence model PATIENT-FOCUSED TEAM  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

4. The primary care excellence model Group Health Centre is the health care partnership of the Sault Ste. Marie and District Group Health Association and the Algoma 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. The primary care excellence model Colorectal Cancer (CRC) Facts  2 nd deadliest cancer in Canada  2 nd 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.www.health.gov.on.ca

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

7. The primary care excellence model 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. The primary care excellence model 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. The primary care excellence model 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. The primary care excellence model 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. The primary care excellence model 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. The primary care excellence model 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. The primary care excellence model Patient Options:  Book an in-office appointment with Navigator  Book a telephone appointment with Navigator  Complete survey only  Decline any participation in study

14. The primary care excellence model 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. The primary care excellence model 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. The primary care excellence model Intervention Components  Patient Navigator provides education on CRC  Patient’s medical history is discussed and assessed  Patient’s CRC screening options are reviewed

17. The primary care excellence model 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. The primary care excellence model Electronic Study Chart

19. The primary care excellence model 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. The primary care excellence model 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. The primary care excellence model Questions?