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Open Access Highly Accessed Research article

A multilevel intervention to promote colorectal cancer screening among community health center patients: results of a pilot study

Karen E Lasser1*, Jennifer Murillo2, Elizabeth Medlin3, Sandra Lisboa4, Lisa Valley-Shah5, Robert H Fletcher6, Karen M Emmons7 and John Z Ayanian8

Author Affiliations

1 Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA

2 Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, USA

3 Centers for Disease Control and Prevention, Atlanta, GA, USA

4 Department of Community Affairs, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, USA

5 Department of Gastroenterology, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, USA

6 Department of Ambulatory Care and Prevention/Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA, USA

7 Dana Farber Cancer Institute/Harvard School of Public Health, Boston, MA, USA

8 Division of General Medicine, Brigham and Women's Hospital and Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

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BMC Family Practice 2009, 10:37  doi:10.1186/1471-2296-10-37

Published: 29 May 2009



Colorectal cancer screening rates are low among poor and disadvantaged patients. Patient navigation has been shown to increase breast and cervical cancer screening rates, but few studies have looked at the potential of patient navigation to increase colorectal cancer screening rates.


The objective was to determine the feasibility and effectiveness of a patient navigator-based intervention to increase colorectal cancer screening rates in community health centers. Patients at the intervention health center who had not been screened for colorectal cancer and were designated as "appropriate for outreach" by their primary care providers received a letter from their provider about the need to be screened and a brochure about colorectal cancer screening. Patient navigators then called patients to discuss screening and to assist patients in obtaining screening. Patients at a demographically similar control health center received usual care.


Thirty-one percent of intervention patients were screened at six months, versus nine percent of control patients (p < .001).


A patient navigator-based intervention, in combination with a letter from the patient's primary care provider, was associated with an increased rate of colorectal cancer screening at one health center as compared to a demographically similar control health center. Our study adds to an emerging literature supporting the use of patient navigators to increase colorectal cancer screening in diverse populations served by urban health centers.