BACKGROUND/RATIONALE:
Non-adherence to colonoscopy (estimated to be about 25% to 45%), contributes to CRC-related morbidity and mortality. Patient navigation has been shown to increase rates of CRC screening as well as colonoscopy completion. A navigator program that consists of laypersons or peers, may be effective in improving adherence to colonoscopy among Veterans. The goals of this project (as part of the CDA "Program to Improve Adherence to Colonoscopy: Interviews with Veterans") were to develop a peer coach intervention using laypersons as peer coaches to help Veterans navigate the steps involved in successful colonoscopy completion.

OBJECTIVE(S):
Our aims included the identification of barriers and facilitators to colonoscopy as perceived by Veterans, development of a Toolkit to serve as a resource manual for peer coaches, development of a recruitment and training program for peer coaches using motivational interviewing skills, and pilot studies to evaluate the feasibility of using peer coaches.

METHODS:
To achieve our aims, we conducted a qualitative study using focus groups and semi-structured interviews to identify barriers to colonoscopy completion. We also conducted a prospective single-center study of patient factors, including psychosocial variables, health literacy, and knowledge that may be associated with adherence to colonoscopy completion. These predictors can be used to help identify at-risk populations who might benefit from peer coaches. We developed a Toolkit based on the facilitators identified from the focus groups. and developed a training program that focuses on knowledge enhancement using didactic lectures, interactive communication skills development, and hands-on practice using motivational interviewing skills.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
The incidence of CRC in veterans is currently estimated to be 4,000 cases annually. Programs that successfully improve adherence to colonoscopy completion are critical for reducing CRC-related morbidity and mortality among veterans. Tailored interventions using Peer Coaches may improve adherence rates not only for colonoscopy but also for other conditions or disease states. Future work should focus on the impact of using peer coaches on patient-important outcomes as well as on implementation of a peer coach program in the VA.

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External Links for this Project

NIH Reporter

Grant Number: IK2HX000772-01
Link: https://reporter.nih.gov/project-details/8201717

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PUBLICATIONS:

Journal Articles

1. Yang D, Summerlee R, Rajca B, Williamson JB, LeLaurin J, McClellan L, Collins D, Sultan S. A pilot study to evaluate the feasibility of implementing a split-dose bowel preparation for inpatient colonoscopy: a single-center experience. BMJ open gastroenterology. 2015 Feb 6; 1(1):e000006. [view]
2. Vege SS, Ziring B, Jain R, Moayyedi P, Clinical Guidelines Committee, American Gastroenterology Association. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015 Apr 1; 148(4):819-22; quize12-3. [view]
3. Rubenstein JH, Enns R, Heidelbaugh J, Barkun A, Clinical Guidelines Committee. American Gastroenterological Association Institute Guideline on the Diagnosis and Management of Lynch Syndrome. Gastroenterology. 2015 Sep 1; 149(3):777-82; quiz e16-7. [view]
4. Weinberg DS, Smalley W, Heidelbaugh JJ, Sultan S, Amercian Gastroenterological Association. American Gastroenterological Association Institute Guideline on the pharmacological management of irritable bowel syndrome. Gastroenterology. 2014 Nov 1; 147(5):1146-8. [view]
5. Reddy KR, Beavers KL, Hammond SP, Lim JK, Falck-Ytter YT, American Gastroenterological Association Institute. American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology. 2015 Jan 1; 148(1):215-9; quiz e16-7. [view]
6. Chang L, Lembo A, Sultan S. American Gastroenterological Association Institute Technical Review on the pharmacological management of irritable bowel syndrome. Gastroenterology. 2014 Nov 1; 147(5):1149-72.e2. [view]
7. Sultan S, Partin MR, Shah P, LeLaurin J, Freytes IM, Nightingale CL, Fesperman SF, Curbow BA, Beyth RJ. Barriers and facilitators associated with colonoscopy completion in individuals with multiple chronic conditions: a qualitative study. Patient preference and adherence. 2017 May 24; 11:985-994. [view]
8. Curbow BA, Dailey AB, King-Marshall EC, Barnett TE, Schumacher JR, Sultan S, George TJ. Pathways to colonoscopy in the South: seeds of health disparities. American journal of public health. 2015 Apr 1; 105(4):e103-11. [view]

Conference Presentations

1. Sultan S, Falck-Ytter Y. Practical Implication of Guidelines: Why the AGA uses GRADE methodology? Paper presented at: Digestive Disease Week / American Gastroenterological Association Annual Conference; 2015 May 17; Washington, DC. [view]

DRA: Aging, Older Veterans' Health and Care, Cancer
DRE: Prevention, Diagnosis
Keywords: none
MeSH Terms: none