To encourage patients to get colorectal cancer screenings, the cost of reminder mailings may be less expensive, but the personal touch of a reminder from a nurse navigator is more effective, according to research at Christiana Care Health System. Colorectal cancer screenings save lives, and finding the disease at an early stage means that treatment can lead to a cure. Yet, many people do not receive regular screenings such as a colonoscopy, typically performed every 10 years starting at age 50.
Christiana Care’s Heather Bittner Fagan, M.D., MPH, FAAFP, and Nora C. Katurakes, MSN, RN, OCN, are focused on ensuring that more patients receive screenings. Their research paper studying the cost effectiveness of interventions to encourage colorectal cancer screenings — a follow-up to an earlier study evaluating the impact of the interventions — was published in the April 2014 edition of the medical journal Cancer.
The research measured the cost of a standard intervention that involved reminder mailings to patients and a tailored navigation intervention, which combined mailings with personal follow-up calls by nurse navigators. The standard intervention cost $167 per patient, and the tailored navigation intervention cost $289 per patient. The tailored navigation intervention was significantly more effective in prompting patients to undergo colorectal cancer screenings.
“It’s not surprising that the standard intervention increased the rate of patients receiving screenings, and that the warm touch of a nurse navigator increased those rates even more,” said Dr. Fagan, associate vice chair of research in Family & Community Medicine and a scholar at Christiana Care’s Value Institute. “There are no simple yes or no answers to the cost-effectiveness of an intervention. Once it is determined that an intervention has benefit, the question becomes: How valuable is that benefit to the health care system, to the doctors and most importantly to the patients?”
She said that once the initial planning, personnel hiring and training are complete, the cost will decrease. Also, an intervention such as the tailored navigation intervention could be adapted to address other patient care needs. In addition, she said, nurse navigators in primary care settings may provide additional, less quantifiable benefits to patients.
“For instance, the patient may come away with greater confidence and ability to make health decisions and take actions to improve their health,” said Dr. Fagan. “Certain populations may need more intense interventions, and part of the next step is discovering who those groups are.”
Also, new or complicated testing may require an extra layer of support from a nurse navigator. “In lung cancer screening, which is newly recommended, the process of getting patients tested and helping them deal with the results is complicated and somewhat uncharted territory for patients and their doctors,” she said.
As a primary care physician, Dr. Fagan regularly calls upon nurse navigators at Christiana Care’s Helen F. Graham Cancer Center & Research Institute to intervene when she has patients who are not following through with necessary screenings. The Graham Cancer Center is one of the most advanced in the U.S. and among a select group invited to participate in the National Cancer Institute Community Cancer Centers Program, helping to shape cancer care delivery, offering outstanding community outreach, and advocating for prevention and treatment in our region.
“At Christiana Care, we’ve been focusing on nurse navigation for several years, beginning in oncology,” said Katurakes, who serves as manager of Community Health Outreach and Education at the Graham Cancer Center. “More recently, our focus has shifted to population health — helping patients to stay healthy by navigating the health care system when they are well rather than sick. Ensuring that patients receive the proper screenings is critical to preventive care.”