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Delaware Eliminates Racial Disparities in Colorectal Cancer

Potera, Carol

AJN The American Journal of Nursing: July 2013 - Volume 113 - Issue 7 - p 16
doi: 10.1097/01.NAJ.0000431904.27355.62
In the News

Outreach, patient navigation, and care coordination add to the program's success.

An innovative program has virtually erased racial disparities in colorectal cancer screening and treatment in Delaware. In 2003, the state teamed up with hospitals and health care providers to form the Delaware Cancer Consortium, which provides screening for colorectal cancer, free treatment for uninsured patients, and special educational efforts to reach Delaware's black community.

Nurse navigators and care coordinators oversaw the program at five acute care hospitals. They recruited patients for colonoscopies and coordinated their care, “navigating” them through the system. Through 2011, more than 5,000 screenings were performed and 10,000 navigations were executed.

Outreach efforts were designed to be culturally appropriate. For example, billboards and newspaper ads show a local black physician who works at a federally funded health clinic.

“When people in that community saw their own physician, the message connected,” says Nora Katurakes, a founding member of the consortium and director of the Community Health Outreach and Education Department at the Helen F. Graham Cancer Center.

Outreach efforts also extended into faith-based communities to raise awareness of colorectal cancer screening. Ministers led the charge in some cases; in others it was a nurse, one who attended a particular church. “It's all about finding a collaborative partner in a community and forming a relationship to start the discussion,” says Katurakes.

Nurses provided education on why colorectal screening is important and where to go. Then they helped people find high-quality treatment after a diagnosis and overcome barriers.

“You can't just hand people a brochure and assume they'll get screened. It probably won't happen,” says Katurakes. Education is just the first step, she says. “Then you have to motivate people to take action and move them through the system.”

Between 2001 and 2009, the incidence of advanced colorectal cancer in black Delawareans fell from 79% to 40%. Screening rates rose from 48% to 74%, and the rate of death fell by 42%, bringing both measurements into parity with those among whites in Delaware.

The results achieved in Delaware could be replicated nationwide, say the study's authors, in which case, they estimate, 4,200 fewer blacks would be diagnosed with colorectal cancer each year and 2,700 fewer patients would die. The screening program costs $1.15 per resident, or $1 million yearly, but it saves $8.5 million a year in cancer treatments because more cancers are caught early. Other medical problems, such as lung cancer and infant mortality, could benefit from similar interventions, says Katurakes. — Carol Potera

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Grubbs SS, et al. J Clin Oncol. 2013;31(16):1928–30
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