Increasing referral rate for screening colonoscopy through patient education and activation at a primary care clinic in New York City.

OBJECTIVE: Colorectal cancer could be prevented through regular screening. Individuals age 50 and older are recommended to get screened via colonoscopy. Because physician referral is a major predictor of colonoscopy completion, two low-cost, evidence-based interventions were tested to increase referrals by activating patients to self-advocate. METHODS: This study compared the impact of a pre-visit educational handout that prompts patients to discuss colonoscopy with their physician with the handout plus brief counseling through exit interviews and chart reviews. The main outcome was physician referral. RESULTS: Medical charts were reviewed for eligibility: 130 control patients (Arm 1), 45 patients who received the educational handout and health counseling (Arm 2), and 50 patients who received only the handout (Arm 3). Colonoscopy referral rates increased from 24.6% in Arm 1 to 44.4% and 52.0% in Arms 2 and 3, respectively (p=0.001). The proportion of exit interview participants who discussed colonoscopy with their doctor increased from 68.8% in Arm 1 to 76.5% and 88.9% in Arms 2 and 3, respectively. CONCLUSIONS: Results indicate that both interventions are effective at increasing colonoscopy referrals. PRACTICAL IMPLICATIONS: Results suggest that an educational handout alone is sufficient in prompting patient-initiated discussions about colonoscopy.

The Human Rights and Social Justice Scholars Program: a collaborative model for preclinical training in social medicine.

BACKGROUND: Despite the importance of the role social justice takes in medical professionalism, the need to train health professionals to address social determinants of health, and medical trainees' desire to eliminate health disparities, undergraduate medical education offers few opportunities for comprehensive training in social justice. The Human Rights and Social Justice (HRSJ) Scholars Program at the Icahn School of Medicine at Mount Sinai is a preclinical training program in social medicine consisting of 5 components: a didactic course, faculty and student mentorship, research projects in social justice, longitudinal policy and advocacy service projects, and a career seminar series. OBJECTIVES: The aim of this article is to describe the design and implementation of the HRSJ curriculum with a focus on the cornerstone of the HRSJ Scholars Program: longitudinal policy and advocacy service projects implemented in collaboration with partner organizations in East Harlem. Furthermore, we describe the results of a qualitative survey of inaugural participants, now third-year medical students, to understand how their participation in this service-learning component affected their clinical experiences and professional self-perceptions. CONCLUSION: Ultimately, through the implementation and evaluation of the HRSJ Scholars Program, we demonstrate an innovative model for social justice education; the enduring effect of service-learning experiences on participants' knowledge, skills, and attitudes; and the potential to increase community capacity for improved health through a collaborative educational model.

Narrative message targets within the decision-making process to undergo screening colonoscopy among Latinos: a qualitative study.

Colorectal cancer (CRC) is a preventable yet leading cause of cancer mortality among Latinos in the USA. Cultural targeting and narrative messaging are two strategies to increase the low screening colonoscopy rates among Latinos. This study identifies key messages for educational interventions aiming to increase screening colonoscopy used among Latinos and proposes a model to understand the relationship between factors involved in colonoscopy decision-making. Individual in-depth interviews were conducted with 12 Latino participants primarily of Puerto Rican descent on the topics of CRC knowledge, barriers and facilitators to colonoscopy use, and the use of narrative in colorectal health messaging. Knowledge about colorectal anatomy and the anesthesia component of colonoscopy procedure is low. Fear of procedure-related pain and fear of treatment-related burden following a cancer diagnosis are significant barriers to colonoscopy. Fear of disease-related suffering and death following a cancer diagnosis and fear of regret are strong facilitators and can be augmented by cancer narratives. Storytelling is commonly used in Latino culture and is an acceptable method to educate the Latino community about CRC screening via colonoscopy. Machismo is a unique barrier to colonoscopy for Latino men via homophobia and reluctance to seek healthcare. A preliminary model to understand factors in colonoscopy decision-making among Latinos is presented. Counseling practices and educational interventions that use culturally targeted narrative health messaging to mediate fears and increase colonoscopy knowledge may increase screening colonoscopy use among Latinos.