Cancer Screening: Patient Navigation Services to Increase Colorectal Cancer Screening and Advance Health Equity

The CPSTF finding is based on evidence from a systematic review that examined intervention effectiveness in increasing breast, cervical, or colorectal cancer screening. The review included 34 studies identified from an existing systematic review (Nelson et al. 2020; search period January 1996 to July 2019) and an updated search (search period through November 2021).

Of the 34 included studies, 27 evaluated intervention effects on colorectal cancer screening.

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to cancer prevention and control.

Screening for colorectal cancer, combined with appropriate follow-up diagnosis and treatment, can reduce cancer incidence and mortality (USPSTF 2021). In 2018, colorectal cancer screening rates in the United States were below the Healthy People 2020 targets, and Healthy People 2030 adjusted their targets based on 2018 data. Rates are even lower among people from historically disadvantaged racial and ethnic groups, people qualifying for Medicaid, and people who do not have health insurance (Sabatino et al. 2021). Identifying and expanding the use of evidence-based interventions to increase screenings can help reduce screening disparities.

Patient navigation services were designed to eliminate barriers and promote access to timely diagnosis and treatment of cancer (Freeman et al. 2011). These services guide patients through healthcare system barriers from pre-diagnosis through all phases of the cancer treatment (Freeman et al. 2011). Barriers may be financial or structural or associated with communication or access to information (CDC 2021). Barriers may also include patients’ mistrust of the healthcare system or fear of possible cancer diagnoses (CDC 2021; Freeman et al. 2011).

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 27 studies. Patient navigation interventions increased colorectal cancer screening for all types of screening.

• Received colorectal cancer screening using any colorectal cancer screening test recommended by USPSTF
  • Colorectal cancer screening increased by a median of 13.6 percentage points or 76.2% (26 studies)
  • Meta-analysis: risk ratio of 1.82, 95% CI 1.50 to 2.21 (26 studies)
• Received colorectal cancer screening using colonoscopy
  • Colorectal cancer screening increased by a median of 13.9 percentage points or 109.9% (12 studies)
  • Meta-analysis: risk ratio of 1.97, 95% CI 1.34 to 2.89 (11 studies)
• Received colorectal cancer screening using FOBT or FIT
  • Colorectal cancer screening increased by a median of 12.4 percentage points or 57.3% (12 studies)
  • Meta-analysis: risk ratio of 1.65, 95% CI 1.38 to 1.99 (12 studies)

A systematic review of economic evidence has not been conducted.

Based on results from the systematic review, findings are applicable to adults and older adults with different baseline screening status, across educational levels, employment, and insurance status.

Evidence suggests programs can be offered in urban or rural settings, include different intervention components, and be delivered by a range of providers who work alone or as part of a team.

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. Evidence gaps were identified for breast, cervical, and colorectal cancer screenings. (What are evidence gaps?)

CPSTF identified the following questions as priorities for research and evaluation:

• How effective are patient navigation services in increasing the following?
  • Repeat screenings (the U.S. Preventive Services Task Force recommends repeating breast, cervical, and colorectal cancer screenings at appropriate intervals [USPSTF 2016, 2018, 2021]); the included studies examined one-time screenings
  • The proportion of patients with positive screening tests who receive follow-up diagnostic tests
  • Cervical cancer screening for younger females (USPSTF recommends females start regular cervical cancer screening at age 21 years [USPSTF 2018]); the included studies recruited participants with a median age of 59.5 years.

Remaining questions for research and evaluation identified by CPSTF:

• How effective are patient navigation services in increasing the following?
  • Cervical cancer screening that includes HPV tests (following the 2018 update from USPSTF that recommended high risk HPV testing alone or in combination with cytology for women aged 30 to 65 years)
  • Colorectal cancer screening for adults aged 45-49 years (following the 2021 update from USPSTF that lowered the starting age for colorectal cancer screenings)
  • Colorectal cancer screening using other USPSTF-recommended tests such as the stool DNA test, flexible sigmoidoscopy, or computed tomography colonography
• Does intervention effectiveness vary by the following?
  • Participants’ health literacy
  • Number of interactions between service deliverers and participants

The following characteristics describe the 34 included studies across all three cancer types.

• All included studies were conducted in the United States.
• Studies were conducted in clinic (22 studies) or clinic and community (12 studies) settings, and in urban (26 studies), rural (5 studies), or a mix of urban and rural areas (2 studies).
• Study participants had a mean age of 59.5 years (25 studies), self-identified as American Indian or Alaska Native (1 study), Asian (4 studies), Black or African American (15 studies), Hispanic or Latino (11 studies), Native Hawaiian (1 study), or White (14 studies).
• Among studies that reported on income and education, the majority of study participants had annual incomes below 150% of the federal poverty level (16 studies), and had a high school education or less (14 studies).
• Interventions offered one to six services including assistance with appointment scheduling (20 studies) or transportation (13 studies), reductions in administrative barriers (23 studies), and one-on-one education (24 studies).
• Services were delivered remotely (15 studies) or both remotely and face-to-face (18 studies); no services were delivered face-to-face only.
• Services were most often delivered by CHWs or dedicated patient navigators who worked alone (CHWs, 6 studies; navigator, 14 studies) or on a team (CHWs, 3 studies; navigator, 6 studies).

Effectiveness Review

• Logic Model – Effectiveness Review [PDF (Print Only) – 165 KB]
• Text Description – Effectiveness Review [PDF – 143 KB]

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Effectiveness Review

• Summary Evidence Table – Effectiveness Review [PDF – 492 KB]

The number of studies and publications do not always correspond (e.g., a publication may include several studies, or one study may be explained in several publications).

Effectiveness Review

Baker DW, Brown T, Buchanan DR, et al. Comparative effectiveness of a multifaceted intervention to improve adherence to annual colorectal cancer screening in community health centers: a randomized clinical trial. JAMA Internal Medicine 2014;174(8):1235-41.

Blumenthal D, Smith S, Majett C, et al. A trial of three interventions to promote colorectal cancer screening in African Americans. Cancer 2010;116(4):922-9.

Braun KL, Thomas Jr WL, Domingo JLB, et al. Reducing cancer screening disparities in Medicare beneficiaries through cancer patient navigation. Journal of American Geriatric Society 2015;63(2):365-70.

Christie J, Itzkowitz S, Lihau-Nkanza I, et al. A randomized controlled trial using patient navigation to increase colonoscopy screening among low-income minorities. Journal of the National Medical Association 2008;100(3):278-84.

Coronado GD, Petrik AF, Vollmer WM, et al. Effectiveness of a mailed colorectal cancer screening outreach program in community health clinics: the STOP CRC Cluster Randomized Clinical Trial. JAMA Internal Medicine 2018;178(9):1174-81.

Davis T, Arnold C, Rademaker A, et al. Improving colon cancer screening in community clinics. Cancer 2013;119(21):3879-86.

DeGroff A, Schroy III PC, Morrissey KG, et al. Patient navigation for colonoscopy completion: results of an RCT. American Journal of Preventive Medicine 2017;53(3):363-72.

Dietrich A, Tobin J, Cassells A, et al. Telephone care management to improve cancer screening among low-income women: a randomized, controlled trial. Annals of Internal Medicine 2006;144(8):563-71.

Dietrich AJ, Tobin JN, Robinson CM, et al. Telephone outreach to increase colon cancer screening in Medicaid managed care organizations: a randomized controlled trial. Annals of Family Medicine 2013;11(4):335-43.

Enard K, Nevarez L, Hernandez M, et al. Patient navigation to increase colorectal cancer screening among Latino Medicare enrollees: a randomized controlled trial. Cancer Causes & Control 2015;26(9):1351-9.

Fiscella K, Humiston S, Hendren S, et al. A multimodal intervention to promote mammography and colorectal cancer screening in a safety-net practice. Journal of the National Medical Association 2011;103(8):762-8.

Ford ME, Havstad S, Vernon SW, et al. Enhancing adherence among older African American men enrolled in a longitudinal cancer screening trial. Gerontologist 2006;46(4):545-50.

Fortuna RJ, Idris A, Winters P, et al. Get Screened: a randomized trial of the incremental benefits of reminders, recall, and outreach on cancer screening. Journal of General Internal Medicine 2014;29(1):90-7.

Goldman SN, Liss DT, Brown T, et al. Comparative effectiveness of multifaceted outreach to initiate colorectal cancer screening in community health centers: a randomized controlled trial. Journal of General Internal Medicine 2015;30(8):1178-84.

Hardin V, Tangka FK, Wood T, et al. The effectiveness and cost to improve colorectal cancer screening in a federally qualified homeless clinic in eastern Kentucky. Health Promotion Practice 2020;21(6):905-9.

Haverkamp D, English K, Jacobs-Wingo J, et al. Effectiveness of interventions to increase colorectal cancer screening among American Indians and Alaska Natives. Preventing Chronic Disease 2020;17:E62.

Honeycutt S, Green R, Ballard D, et al. Evaluation of a patient navigation program to promote colorectal cancer screening in rural Georgia, USA. Cancer 2013;119(16):3059-66.

Jandorf L, Gutierrez Y, Lopez J, et al. Use of a patient navigator to increase colorectal cancer screening in an urban neighborhood health clinic. Journal of Urban Health 2005;82(2):216-24.

Lasser KE, Murillo J, Lisboa S, et al. Colorectal cancer screening among ethnically diverse, low-income patients: a randomized controlled trial. Archives Internal Medicine 2011;171(10):906-12.

Leone LA, Reuland DS, Lewis CL, et al. Reach, usage, and effectiveness of a Medicaid patient navigator intervention to increase colorectal cancer screening, Cape Fear, North Carolina, 2011. Preventing Chronic Disease 2013;10:E82.

Ma GX, Shive S, Tan Y, et al. Community-based colorectal cancer intervention in underserved Korean Americans. Cancer Epidemiology 2009;33:381-6.

Ma GX, Lee M, Beeber M, et al. Community-clinical linkage intervention to improve colorectal cancer screening among underserved Korean Americans. Cancer Health Disparities 2019;3:e1-5.

Myers RE, Sifri R, Daskalakis C, et al. Increasing colon cancer screening in primary care among African Americans. Journal of the National Cancer Institute 2014;106(12):dju344.

Myers RE, Stello B, Daskalakis C, et al. Decision support and navigation to increase colorectal cancer screening among Hispanic patients. Cancer Epidemiology Biomarkers and Prevention 2019;28(2):384-91.

Percac-Lima S, Grant RW, Green AR, et al. A culturally tailored navigator program for colorectal cancer screening in a community health center: a randomized, controlled trial. Journal of General Internal Medicine 2009;24(2):211-7.

Percac‐Lima S, López L, Ashburner JM, et al. The longitudinal impact of patient navigation on equity in colorectal cancer screening in a large primary care network. Cancer 2014;120(13):2025-31.

Reuland DS, Brenner AT, Hoffman R, et al. Effect of combined patient decision aid and patient navigation vs usual care for colorectal cancer screening in a vulnerable patient population: a randomized clinical trial. JAMA Internal Medicine 2017;177(7):967-74.

Reaching Communities through Patient Navigation: Evidence for Action (May 2, 2023)
Hosted by the American Cancer Society National Navigation Roundtable, the webinar features speakers from The Community Guide, the Professional Oncology Navigation Task Force, and CDC’s Community Guide Program and Division of Cancer Control and Prevention

Oncology Navigation Standards of Professional Practice
These standards provide clinical oncology nurse navigators, social work navigators, and patient navigators clear information about best practices in the provision of professional care.
Developed by the Academy of Oncology Nurse & Patient Navigators and other organizations of the Professional Oncology Navigation Task Force

New Hampshire Colorectal Cancer Screening Program Patient Navigation Model Replication Manual
This manual describes how to implement the patient navigation model developed by the New Hampshire Colorectal Cancer Screening Program.
Funded and evaluated by CDC’s Colorectal Cancer Control Program

National Navigation Roundtable (NNRT) Resource Center
NNRT offers resources to support the patient navigation services community.
Hosted by the American Cancer Society

Effectiveness Review

The review included studies from a published systematic review (Nelson et al. 2020, 29 studies; search period January 1, 1996, to July 6, 2019) and an updated search (5 studies; search period July 1, 2019, to November 30, 2021). The updated search used the same search strategy from Nelson et al., with detailed search strategy and results listed below. Two team members independently screened each paper identified to determine eligibility. Uncertainties and disagreements were resolved by consensus among review team members.

Appendix A. Literature Search Strategies

Database: Ovid MEDLINE® July 2019 thru Nov 2021

Broad search:

1 Healthcare Disparities/

2 “Health Services Needs and Demand”/

3 exp Health Services Accessibility/

4 exp Socioeconomic Factors/

5 Minority Groups/

6 exp Population Groups/

7 vulnerable populations/ or working poor/

8 exp Disabled Persons/

9 exp Sexual Minorities/

10 Minority Health/

11 cultural competency/ or cultural diversity/

12 1 or 2 or 3

13 or/4-11

14 13 and (equity or equitable or equal* or fair or parity or unequal* or inequal* or inequit* or undertreat* or under-treat* or access* or disparit* or discriminat*).ti,ab,kw.

15 12 or 14

16 exp Preventive Health Services/

17 exp Mass Screening/

18 exp Health Promotion/

19 (“United States Preventive Services Task Force” or “U.S. Preventive Services Task Force” or “U.S.P.S.T.F.” or “USPSTF”).ti,ab,kw,au.

20 or/16-19

21 exp diabetes mellitus, type 2/ or prediabetic state/

22 exp Cardiovascular Diseases/

23 Aspirin/

24 exp breast neoplasms/ or exp colorectal neoplasms/ or exp lung neoplasms/ or uterine cervical neoplasms/

25 exp Obesity/

26 Smoking/

27 exp “Tobacco Use Cessation”/

28 21 or (22 and 23) or 24 or 25 or 26

29 27 or 28

30 29 and pc.fs.

31 20 or 30

32 15 and 31

33 exp united states/ or baltimore/ or boston/ or chicago/ or “district of columbia”/ or los angeles/ or new york city/ or san francisco/

34 (“united states” or “u.s.” or alabama or alaska or arizona or arkansas or california or colorado or connecticut or delaware or florida or georgia or hawaii or idaho or illinois or indiana or iowa or kansas or kentucky or louisiana or maine or maryland or massachusetts or michigan or minnesota or mississippi or missouri or montana or nebraska or nevada or “new hampshire” or “new jersey” or “new mexico” or “new york” or “north carolina” or “north dakota” or ohio or oklahoma or oregon or pennsylvania or “rhode island” or “south carolina” or “south dakota” or tennesee or texas or utah or vermont or virginia or washington or “west virginia” or wisconsin or wyoming).ti,ab,kw.

35 32 and (33 or 34)

36 africa/ or caribbean region/ or central america/ or canada/ or greenland/ or mexico/ or south america/ or exp asia/ or exp europe/

37 35 not 36

38 limit 37 to (meta analysis or systematic reviews)

39 (medline or systematic or metaanalysis or “meta analysis”).ti,ab.

40 37 and 39

41 38 or 40

42 limit 41 to english language

43 37 not 42

44           (201907* or 201908* or 201909* or 201910* or 201911* or 201912* or 2020* or 2021*).dt.

45           43 and 44            867

Focused search: evidence gaps

1             Healthcare Disparities/   20269

2             “Health Services Needs and Demand”/    54678

3             exp Health Services Accessibility/              120117

4             exp Socioeconomic Factors/        481169

5             Minority Groups/             15822

6             exp Population Groups/ 321010

7             vulnerable populations/ or working poor/             12188

8             exp Disabled Persons/    69810

9             exp Sexual Minorities/    10967

10           Minority Health/              861

11           cultural competency/ or cultural diversity/            17597

12           1 or 2 or 3           180299

13           or/4-11 849167

14           13 and (equity or equitable or equal* or fair or parity or unequal* or inequal* or inequit* or undertreat* or under-treat* or access* or disparit* or discriminat*).ti,ab,kw.               120769

15           12 or 14               275025

16           exp Preventive Health Services/ 636769

17           exp Mass Screening/       137402

18           exp Health Promotion/   81963

19           (“United States Preventive Services Task Force” or “U.S. Preventive Services Task Force” or “U.S.P.S.T.F.” or “USPSTF”).ti,ab,kw,au.               3039

20           or/16-19              650299

21           exp diabetes mellitus, type 2/ or prediabetic state/          154697

22           exp Cardiovascular Diseases/      2555761

23           Aspirin/ 46715

24           exp breast neoplasms/ or exp colorectal neoplasms/ or exp lung neoplasms/ or uterine cervical neoplasms/         833088

25           exp Obesity/       235735

26           Smoking/             145101

27           exp “Tobacco Use Cessation”/     1324

28           21 or (22 and 23) or 24 or 25 or 26           1340617

29           27 or 28               1341591

30           29 and pc.fs.      119957

31           20 or 30               737319

32           15 and 31            31442

33           exp united states/ or baltimore/ or boston/ or chicago/ or “district of columbia”/ or los angeles/ or new york city/ or san francisco/   1413746

34           (“united states” or “u.s.” or alabama or alaska or arizona or arkansas or california or colorado or connecticut or delaware or florida or georgia or hawaii or idaho or illinois or indiana or iowa or kansas or kentucky or louisiana or maine or maryland or massachusetts or michigan or minnesota or mississippi or missouri or montana or nebraska or nevada or “new hampshire” or “new jersey” or “new mexico” or “new york” or “north carolina” or “north dakota” or ohio or oklahoma or oregon or pennsylvania or “rhode island” or “south carolina” or “south dakota” or tennesee or texas or utah or vermont or virginia or washington or “west virginia” or wisconsin or wyoming).ti,ab,kw.            1177507

35           32 and (33 or 34)             12684

36           “Social Determinants of Health”/              4973

37           35 or 36               17553

38           37 and (gap* or limit* or lack* or barrier*).ti,ab. 4878

39           (201907* or 201908* or 201909* or 201910* or 201911* or 201912* or 2020* or 2021*).dt.           3543456

40           38 and 39            857

41           limit 40 to english language         849

849

Focused search: breast cancer screening

CG Nelson Updated CGO 112621 breast cancer final”

1. Healthcare Disparities/
2. “Health Services Needs and Demand”/
3. exp Health Services Accessibility/
4. exp Socioeconomic Factors/
5. Minority Groups/
6. exp Population Groups/
7. vulnerable populations/ or working poor/
8. exp Disabled Persons/
9. exp Sexual Minorities/
10. Minority Health/
11. cultural competency/ or cultural diversity/
12. 1 or 2 or 3
13. or/4-11
14. 13 and (equity or equitable or equal* or fair or parity or unequal* or inequal* or inequit* or undertreat* or under-treat* or access* or disparit* or discriminat*).ti,ab,kw.
15. 12 or 14
16. exp Preventive Health Services/
17. exp Mass Screening/
18. exp Health Promotion/
19. (“United States Preventive Services Task Force” or “U.S. Preventive Services Task Force” or “U.S.P.S.T.F.” or “USPSTF”).ti,ab,kw,au.
20. prevent*.ti,ab.
21. 16 or 17 or 18 or 19 or 20
22. 15 and 21
23. exp united states/ or baltimore/ or boston/ or chicago/ or “district of columbia”/ or los angeles/ or new orleans/ or new york city/ or philadelphia/ or san francisco/
24. exp africa/ or caribbean region/ or central america/ or latin america/ or canada/ or greenland/ or mexico/ or south america/ or exp antarctic regions/ or exp arctic regions/ or exp asia/ or exp europe/ or exp islands/ or exp oceania/
25. exp Breast Neoplasms/pc [Prevention & Control]
26. ((breast adj3 cancer) or mammogram or mammography or “clinical breast exam” or (breast adj3 self)).ti,ab,kw.
27. exp Mass Screening/ or exp early diagnosis/
28. screen*.ti,ab,kw.
29. (25 or 26) and (27 or 28)
30. 12 and 21 and 29
31. 14 and 21 and 29
32. 30 or 31
33. 23 and 32
34. 32 not 24
35. 33 or 34
36. (201907* or 201908* or 201909* or 201910* or 201911* or 201912* or 2020* or 2021*).dt.
37. 35 and 36
38. limit 37 to english language

Focused search: cervical cancer screening

1. Healthcare Disparities/
2. “Health Services Needs and Demand”/
3. exp Health Services Accessibility/
4. exp Socioeconomic Factors/
5. Minority Groups/
6. exp Population Groups/
7. vulnerable populations/ or working poor/
8. exp Disabled Persons/
9. exp Sexual Minorities/
10. Minority Health/
11. cultural competency/ or cultural diversity/
12. 1 or 2 or 3
13. or/4-11
14. 13 and (equity or equitable or equal* or fair or parity or unequal* or inequal* or inequit* or undertreat* or under-treat* or access* or disparit* or discriminat*).ti,ab,kw.
15. 12 or 14
16. exp Preventive Health Services/
17. exp Mass Screening/
18. exp Health Promotion/
19. (“United States Preventive Services Task Force” or “U.S. Preventive Services Task Force” or “U.S.P.S.T.F.” or “USPSTF”).ti,ab,kw,au.
20. prevent*.ti,ab.
21. 16 or 17 or 18 or 19 or 20
22. 15 and 21
23. exp united states/ or baltimore/ or boston/ or chicago/ or “district of columbia”/ or los angeles/ or new orleans/ or new york city/ or philadelphia/ or san francisco/
24. exp africa/ or caribbean region/ or central america/ or latin america/ or canada/ or greenland/ or mexico/ or south america/ or exp antarctic regions/ or exp arctic regions/ or exp asia/ or exp europe/ or exp islands/ or exp oceania/
25. Uterine Cervical Neoplasms/
26. ((cervical or cervix) adj3 cancer).ti,ab,kw.
27. exp Mass Screening/ or exp early diagnosis/
28. screen*.ti,ab,kw.
29. (25 or 26) and (27 or 28)
30. 12 and 21 and 29
31. 14 and 21 and 29
32. 30 or 31
33. 23 and 32
34. 32 not 24
35. 33 or 34
36. (201907* or 201908* or 201909* or 201910* or 201911* or 201912* or 2020* or 2021*).dt.
37. 35 and 36
38. limit 37 to english language

Focused search: colon cancer screening

CG Nelson Updated CGO 112621 colon cancer screenings”

1. Healthcare Disparities/
2. “Health Services Needs and Demand”/
3. exp Health Services Accessibility/ or health status disparities/ or “social determinants of health”/
4. exp Socioeconomic Factors/
5. Minority Groups/
6. exp Population Groups/
7. vulnerable populations/ or working poor/
8. exp Disabled Persons/
9. exp Sexual Minorities/
10. Minority Health/
11. cultural competency/ or cultural diversity/
12. 1 or 2 or 3
13. or/4-11
14. 13 and (equity or equitable or equal* or fair or parity or unequal* or inequal* or inequit* or undertreat* or under-treat* or access* or disparit* or discriminat*).ti,ab,kw.
15. 12 or 14
16. exp Preventive Health Services/
17. exp Mass Screening/
18. exp Health Promotion/
19. (“United States Preventive Services Task Force” or “U.S. Preventive Services Task Force” or “U.S.P.S.T.F.” or “USPSTF”).ti,ab,kw,au.
20. prevent*.ti,ab.
21. or/16-20
22. 15 and 21
23. exp united states/ or baltimore/ or boston/ or chicago/ or “district of columbia”/ or los angeles/ or new orleans/ or new york city/ or philadelphia/ or san francisco/
24. exp africa/ or caribbean region/ or central america/ or latin america/ or canada/ or greenland/ or mexico/ or south america/ or exp antarctic regions/ or exp arctic regions/ or exp asia/ or exp europe/ or exp islands/ or exp oceania/
25. exp Colorectal Neoplasms/pc [Prevention & Control]
26. (((colon or colorectal) adj3 cancer) or colonoscopy).ti,ab,kw.
27. exp Mass Screening/
28. screen*.ti,ab,kw.
29. (25 or 26) and (27 or 28)
30. 12 and 21 and 29
31. 14 and 21 and 29
32. 30 or 31
33. 23 and 32
34. 32 not 24
35. 33 or 34
36. (201907* or 201908* or 201909* or 201910* or 201911* or 201912* or 2020* or 2021*).dt.
37. 35 and 36
38. limit 37 to english language

Systematic reviews:

CG Nelson Updated CGO 112621 systematic reviews

1. Healthcare Disparities/
2. “Health Services Needs and Demand”/
3. exp Health Services Accessibility/ or health status disparities/ or “social determinants of health”/
4. exp Socioeconomic Factors/
5. Minority Groups/
6. exp Population Groups/
7. vulnerable populations/ or working poor/
8. exp Disabled Persons/
9. exp Sexual Minorities/
10. Minority Health/
11. cultural competency/ or cultural diversity/
12. 1 or 2 or 3
13. or/4-11
14. 13 and (equity or equitable or equal* or fair or parity or unequal* or inequal* or inequit* or undertreat* or under-treat* or access* or disparit* or discriminat*).ti,ab,kw.
15. 12 or 14
16. exp Preventive Health Services/
17. exp Mass Screening/
18. exp Health Promotion/
19. (“United States Preventive Services Task Force” or “U.S. Preventive Services Task Force” or “U.S.P.S.T.F.” or “USPSTF”).ti,ab,kw,au.
20. or/16-19
21. exp diabetes mellitus, type 2/ or prediabetic state/
22. exp Cardiovascular Diseases/
23. Aspirin/
24. exp breast neoplasms/ or exp colorectal neoplasms/ or exp lung neoplasms/ or uterine cervical neoplasms/
25. exp Obesity/
26. exp “Tobacco Use Cessation”/
27. 21 or (22 and 23) or 24 or 25
28. 26 or 27
29. 28 and pc.fs.
30. 15 and 29
31. exp united states/ or baltimore/ or boston/ or chicago/ or “district of columbia”/ or los angeles/ or new york city/ or san francisco/
32. (“united states” or “u.s.” or alabama or alaska or arizona or arkansas or california or colorado or connecticut or delaware or florida or georgia or hawaii or idaho or illinois or indiana or iowa or kansas or kentucky or louisiana or maine or maryland or massachusetts or michigan or minnesota or mississippi or missouri or montana or nebraska or nevada or “new hampshire” or “new jersey” or “new mexico” or “new york” or “north carolina” or “north dakota” or ohio or oklahoma or oregon or pennsylvania or “rhode island” or “south carolina” or “south dakota” or tennesee or texas or utah or vermont or virginia or washington or “west virginia” or wisconsin or wyoming).ti,ab,kw.
33. 30 and (31 or 32)
34. africa/ or caribbean region/ or central america/ or canada/ or greenland/ or mexico/ or south america/ or exp asia/ or exp europe/
35. 33 not 34
36. limit 35 to (meta analysis or systematic reviews)
37. (medline or systematic or metaanalysis or “meta analysis”).ti,ab.
38. 36 and 37
39. 36 or 38
40. (201907* or 201908* or 201909* or 201910* or 201911* or 201912* or 2020* or 2021*).dt.
41. 39 and 40
42. limit 41 to english language

Database: Ovid MEDLINE® Epub Ahead of Print , In-Process & Other Non-Indexed Citations to July 2019 to Nov 2021

1. ((health or healthcare or “health care” or care) and (equit* or disparit* or inequal* or accessibilit*)).ti,ab,kw.
2. (socioeconomic or economic or poor or vulnerable or disenfranchis* or (social adj3 class)).ti,ab,kw.
3. (divers* or minorit* or ethnicit* or race or racial or black* or “african american*” or asian* or “native american*” or indian or hispanic or latin*).ti,ab,kw.
4. (disabled or challenged or handicapped).ti,ab,kw.
5. (“sexual adj3 minorit*” or homosexual* or bisexual* or gay* or lesbian* or transgender* or queer or lbg*).ti,ab,kw.
6. (“cultural competency” or “cultural diversity”).ti,ab,kw.
7. (preventive or prevention or prevent).ti,ab,kw.
8. screen*.ti,ab,kw.
9. (“United States Preventive Services Task Force” or “U.S. Preventive Services Task Force” or “U.S.P.S.T.F.” or “USPSTF”).ti,ab,kw,au.
10. or/2-6
11. 10 and (equit* or disparit* or inequal* or accessibilit*).ti,ab,kw.
12. 1 or 11
13. 12 and (7 or 8 or 9)
14. (diabetes or glucose or aspirin or cardiovascular or heart or coronary or “myocardial infarction” or stroke or colorectal or colon or breast or cervical or human papillomavirus or HPV or diet or exercise or “physical activity” or overweight or obese or obesity or metabolic or hypertension or “blood pressure” or lung or tobacco or smoke* or smoking).ti,ab,kw.
15. 13 and 14
16. (“united states” or “u.s.” or alabama or AL or alaska or AK or arizona or AZ or arkansas or AR or california or CA or Colorado or CO or Connecticut or CT or delaware or DE or florida or FL or georgia or GA or hawaii or HI or Idaho or ID or Illinois or IL or indiana or iowa or IA or Kansas or KS or kentucky or KY or Louisiana or LA).ti,ab,kw,in.
17. (maine or ME or maryland or MD or Massachusetts or MA or michigan or MI or Minnesota or MN or mississippi or MS or missouri or MO or montana or MT or nebraska or NE or Nevada or NV or “new hampshire” or NH or “new jersey” or NJ or “new mexico” or NM or “new york” or NY or “north carolina” or NC or “north dakota” or ND).ti,ab,kw,in.
18. (ohio or OH or oklahoma or OK or oregon or pennsylvania or PA or “rhode island” or RI or “south carolina” or SC or “south dakota” or SD or tennesee or TN or texas or TX or Utah or UT or vermont or VT or Virginia or VA or Washington or WA or “west virginia” or WV or wisconsin or WI or Wyoming or WY).ti,ab,kw,in.
19. 15 and (16 or 17 or 18)
20. (201907* or 201908* or 201909* or 201910* or 201911* or 201912* or 2020* or 2021*).dt.
21. 19 and 20
22. limit 21 to english language

Database: PsycINFO 1806 to July 2019 thru Nov 2021

CG Nelson Updated CGO 112621 PsycINFO”

1             health disparities/ or treatment barriers/

2             (equit* or disparit* or inequal* or accessibilit*).ti,ab.

3             exp sociocultural factors/

4             exp group differences/

5             minority groups/ or alaska natives/ or american indians/ or asians/ or blacks/ or cultural sensitivity/ or hawaii natives/ or indigenous populations/ or “latinos/latinas”/ or pacific islanders/ or “race and ethnic discrimination”/ or “racial and ethnic groups”/

6             exp disabilities/

7             exp gender identity/

8             exp sexual orientation/

9             (divers* or minorit* or ethnicit* or race or racial or black* or “african american*” or asian* or “native american*” or indian or hispanic or latin*).ti,ab.

10           (“sexual adj3 minorit*” or homosexual* or bisexual* or gay* or lesbian* or transgender* or queer or lbg*).ti,ab.

11           (disabled or challenged or handicapped).ti,ab.

12           (1 or 2) and (or/3-11)

13           exp health promotion/

14           exp DIABETES/

15           exp cardiovascular disorders/

16           exp ASPIRIN/      517

17           exp breast neoplasms/

18           cancer screening/

19           exp overweight/

20           tobacco smoking/ or smoking cessation/

21           (diabetes or glucose or aspirin or cardiovascular or heart or coronary or “myocardial infarction” or stroke or colorectal or colon or breast or cervical or human papillomavirus or HPV or diet or exercise or “physical activity” or overweight or obese or obesity or metabolic or hypertension or “blood pressure” or lung or tobacco or smoke* or smoking).ti,ab.

22           or/13-21

23           12 and 22

24           (“united states” or “u.s.” or alabama or AL or alaska or AK or arizona or AZ or arkansas or AR or california or CA or Colorado or CO or Connecticut or CT or delaware or DE or florida or FL or georgia or GA or hawaii or HI or Idaho or ID or Illinois or IL or indiana or iowa or IA or Kansas or KS or kentucky or KY or Louisiana or LA).ti,ab,in.

25           (maine or ME or maryland or MD or Massachusetts or MA or michigan or MI or Minnesota or MN or mississippi or MS or missouri or MO or montana or MT or nebraska or NE or Nevada or NV or “new hampshire” or NH or “new jersey” or NJ or “new mexico” or NM or “new york” or NY or “north carolina” or NC or “north dakota” or ND).ti,ab,in.

26           (ohio or OH or oklahoma or OK or oregon or pennsylvania or PA or “rhode island” or RI or “south carolina” or SC or “south dakota” or SD or tennesee or TN or texas or TX or Utah or UT or vermont or VT or Virginia or VA or Washington or WA or “west virginia” or WV or wisconsin or WI or Wyoming or WY).ti,ab,in.

27           24 or 25 or 26

28           23 and (24 or 25 or 26)

29           (201907* or 201908* or 201909* or 201910* or 201911* or 201912* or 2020* or 2021*).up.

30           28 and 29

31           limit 30 to english language         907

Database ProQuest Sociological Abstracts July 2019 to Nov 021 ( Ebsco Soc Index not available)

((((noft(((health OR healthcare OR “health care” OR care) AND (equit* OR disparit* OR inequal* OR accessibilit*))) OR ((noft((socioeconomic OR economic OR poor OR vulnerable OR disenfranchis* OR (social NEAR/3 class))) OR noft((divers* OR minorit* OR ethnicit* OR race OR racial OR black* OR “african american*” OR asian* OR “native american*” OR indian OR hispanic OR latin*)) OR noft((disabled OR challenged OR handicapped)) OR noft((“cultural competency” OR “cultural diversity”)) OR noft(((sexual NEAR/3 minorit*) OR homosexual* OR bisexual* OR gay* OR lesbian* OR transgender* OR queer OR lbg*))) AND noft((equit* OR disparit* OR inequal* OR accessibilit*)))) AND (noft((preventive OR prevention OR prevent)) OR noft((“United States Preventive Services Task Force” OR “U.S. Preventive Services Task Force” OR “U.S.P.S.T.F.” OR “USPSTF”)) OR noft(screen*.))) AND noft((diabetes OR glucose OR aspirin OR cardiovascular OR heart OR coronary OR “myocardial infarction” OR stroke OR colorectal OR colon OR breast OR cervical OR human papillomavirus OR HPV OR diet OR exercise OR “physical activity” OR overweight OR obese OR obesity OR metabolic OR hypertension OR “blood pressure” OR lung OR tobacco OR smoke* OR smoking))) AND noft((“United States” OR USA OR “u.s.” OR Alabama OR Alaska OR Arizona OR Arkansas OR California OR Colorado OR Connecticut OR Delaware OR “District of Columbia” OR Florida OR Georgia OR Hawaii OR Idaho OR Illinois OR Indiana OR Iowa OR Kansas OR Kentucky OR Louisiana OR Maine OR Maryland OR Massachusetts OR Michigan OR Minnesota OR Mississippi OR Missouri OR Montana OR Nebraska OR Nevada OR “New Hampshire” OR “New Jersey” OR “New Mexico” OR “New York” OR “North Carolina” OR “North Dakota” OR Ohio OR Oklahoma OR Oregon OR Pennsylvania OR “Rhode Island” OR “South Carolina” OR “South Dakota” OR Tennessee OR Texas OR Utah OR Vermont OR Virginia OR Washington OR “West Virginia” OR Wisconsin OR Wyoming OR “Puerto Rico”))) NOT (stype.exact(“Magazines” OR “Books”) AND pd(20190701-20211129))

Scopus

28

( ( ( ( ( ( TITLE-ABS-KEY ( ( health  OR  healthcare  OR  “health care”  OR  care )  AND  ( equit*  OR  disparit*  OR  inequal*  OR  accessibilit* ) ) )  OR  ( ( TITLE-ABS-KEY ( equit*  OR  disparit*  OR  inequal*  OR  accessibilit* ) )  AND  ( ( TITLE-ABS-KEY ( socioeconomic  OR  economic  OR  poor  OR  vulnerable  OR  disenfranchis*  OR  “social class” ) )  OR  ( TITLE-ABS ( divers*  OR  minorit*  OR  ethnicit*  OR  race  OR  racial  OR  black*  OR  “african american*”  OR  asian*  OR  “native american*”  OR  indian  OR  hispanic  OR  latin* ) )  OR  ( TITLE-ABS ( disabled  OR  challenged  OR  handicapped ) )  OR  ( TITLE-ABS-KEY ( “cultural competency”  OR  “cultural diversity” ) )  OR  ( TITLE-ABS ( “sexual W/3 minorit*”  OR  homosexual*  OR  bisexual*  OR  gay*  OR  lesbian*  OR  transgender*  OR  queer  OR  lbg* ) ) ) ) ) )  AND  ( ( TITLE-ABS-KEY ( preventive  OR  prevention  OR  prevent ) )  OR  ( TITLE-ABS-KEY ( screen* ) )  OR  ( TITLE-ABS-KEY ( “United States Preventive Services Task Force”  OR  “U.S. Preventive Services Task Force”  OR  “U.S.P.S.T.F.”  OR  “USPSTF” ) ) ) )  AND  ( TITLE-ABS-KEY ( diabetes  OR  glucose  OR  aspirin  OR  cardiovascular  OR  heart  OR  coronary  OR  “myocardial infarction”  OR  stroke  OR  colorectal  OR  colon  OR  breast  OR  cervical  OR  human  AND papillomavirus  OR  hpv  OR  diet  OR  exercise  OR  “physical activity”  OR  overweight  OR  obese  OR  obesity  OR  metabolic  OR  hypertension  OR  “blood pressure”  OR  lung  OR  tobacco  OR  smoke*  OR  smoking ) ) ) )  AND  ( TITLE-ABS-KEY ( “United States”  OR  usa  OR  “u.s.”  OR  alabama  OR  alaska  OR  arizona  OR  arkansas  OR  california  OR  colorado  OR  connecticut  OR  delaware  OR  “District of Columbia”  OR  florida  OR  georgia  OR  hawaii  OR  idaho  OR  illinois  OR  indiana  OR  iowa  OR  kansas  OR  kentucky  OR  louisiana  OR  maine  OR  maryland  OR  massachusetts  OR  michigan  OR  minnesota  OR  mississippi  OR  missouri  OR  montana  OR  nebraska  OR  nevada  OR  “New Hampshire”  OR  “New Jersey”  OR  “New Mexico”  OR  “New York”  OR  “North Carolina”  OR  “North Dakota”  OR  ohio  OR  oklahoma  OR  oregon  OR  pennsylvania  OR  “Rhode Island”  OR  “South Carolina”  OR  “South Dakota”  OR  tennessee  OR  texas  OR  utah  OR  vermont  OR  virginia  OR  washington  OR  “West Virginia”  OR  wisconsin  OR  wyoming  OR  “Puerto Rico” ) )  AND  ( PUBDATETXT ( “July 2019”  OR  “August 2019”  OR  “September 2019”  OR  “October 2019”  OR  “November 2019”  OR  “December 2019” )  OR  PUBYEAR  =  2020  OR  PUBYEAR  =  2021 )  AND  ( LIMIT-TO ( LANGUAGE ,  “English” ) ) …

666 document results

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27

( ( ( ( ( ( TITLE-ABS-KEY ( ( health  OR  healthcare  OR  “health care”  OR  care )  AND  ( equit*  OR  disparit*  OR  inequal*  OR  accessibilit* ) ) )  OR  ( ( TITLE-ABS-KEY ( equit*  OR  disparit*  OR  inequal*  OR  accessibilit* ) )  AND  ( ( TITLE-ABS-KEY ( socioeconomic  OR  economic  OR  poor  OR  vulnerable  OR  disenfranchis*  OR  “social class” ) )  OR  ( TITLE-ABS ( divers*  OR  minorit*  OR  ethnicit*  OR  race  OR  racial  OR  black*  OR  “african american*”  OR  asian*  OR  “native american*”  OR  indian  OR  hispanic  OR  latin* ) )  OR  ( TITLE-ABS ( disabled  OR  challenged  OR  handicapped ) )  OR  ( TITLE-ABS-KEY ( “cultural competency”  OR  “cultural diversity” ) )  OR  ( TITLE-ABS ( “sexual W/3 minorit*”  OR  homosexual*  OR  bisexual*  OR  gay*  OR  lesbian*  OR  transgender*  OR  queer  OR  lbg* ) ) ) ) ) )  AND  ( ( TITLE-ABS-KEY ( preventive  OR  prevention  OR  prevent ) )  OR  ( TITLE-ABS-KEY ( screen* ) )  OR  ( TITLE-ABS-KEY ( “United States Preventive Services Task Force”  OR  “U.S. Preventive Services Task Force”  OR  “U.S.P.S.T.F.”  OR  “USPSTF” ) ) ) )  AND  ( TITLE-ABS-KEY ( diabetes  OR  glucose  OR  aspirin  OR  cardiovascular  OR  heart  OR  coronary  OR  “myocardial infarction”  OR  stroke  OR  colorectal  OR  colon  OR  breast  OR  cervical  OR  human  AND papillomavirus  OR  hpv  OR  diet  OR  exercise  OR  “physical activity”  OR  overweight  OR  obese  OR  obesity  OR  metabolic  OR  hypertension  OR  “blood pressure”  OR  lung  OR  tobacco  OR  smoke*  OR  smoking ) ) ) )  AND  ( TITLE-ABS-KEY ( “United States”  OR  usa  OR  “u.s.”  OR  alabama  OR  alaska  OR  arizona  OR  arkansas  OR  california  OR  colorado  OR  connecticut  OR  delaware  OR  “District of Columbia”  OR  florida  OR  georgia  OR  hawaii  OR  idaho  OR  illinois  OR  indiana  OR  iowa  OR  kansas  OR  kentucky  OR  louisiana  OR  maine  OR  maryland  OR  massachusetts  OR  michigan  OR  minnesota  OR  mississippi  OR  missouri  OR  montana  OR  nebraska  OR  nevada  OR  “New Hampshire”  OR  “New Jersey”  OR  “New Mexico”  OR  “New York”  OR  “North Carolina”  OR  “North Dakota”  OR  ohio  OR  oklahoma  OR  oregon  OR  pennsylvania  OR  “Rhode Island”  OR  “South Carolina”  OR  “South Dakota”  OR  tennessee  OR  texas  OR  utah  OR  vermont  OR  virginia  OR  washington  OR  “West Virginia”  OR  wisconsin  OR  wyoming  OR  “Puerto Rico” ) )  AND  ( PUBDATETXT ( “July 2019”  OR  “August 2019”  OR  “September 2019”  OR  “October 2019”  OR  “November 2019”  OR  “December 2019” )  OR  PUBYEAR  =  2020  OR  PUBYEAR  =  2021 ) …

667 document results

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26

( ( ( ( ( ( TITLE-ABS-KEY ( ( health  OR  healthcare  OR  “health care”  OR  care )  AND  ( equit*  OR  disparit*  OR  inequal*  OR  accessibilit* ) ) )  OR  ( ( TITLE-ABS-KEY ( equit*  OR  disparit*  OR  inequal*  OR  accessibilit* ) )  AND  ( ( TITLE-ABS-KEY ( socioeconomic  OR  economic  OR  poor  OR  vulnerable  OR  disenfranchis*  OR  “social class” ) )  OR  ( TITLE-ABS ( divers*  OR  minorit*  OR  ethnicit*  OR  race  OR  racial  OR  black*  OR  “african american*”  OR  asian*  OR  “native american*”  OR  indian  OR  hispanic  OR  latin* ) )  OR  ( TITLE-ABS ( disabled  OR  challenged  OR  handicapped ) )  OR  ( TITLE-ABS-KEY ( “cultural competency”  OR  “cultural diversity” ) )  OR  ( TITLE-ABS ( “sexual W/3 minorit*”  OR  homosexual*  OR  bisexual*  OR  gay*  OR  lesbian*  OR  transgender*  OR  queer  OR  lbg* ) ) ) ) ) )  AND  ( ( TITLE-ABS-KEY ( preventive  OR  prevention  OR  prevent ) )  OR  ( TITLE-ABS-KEY ( screen* ) )  OR  ( TITLE-ABS-KEY ( “United States Preventive Services Task Force”  OR  “U.S. Preventive Services Task Force”  OR  “U.S.P.S.T.F.”  OR  “USPSTF” ) ) ) )  AND  ( TITLE-ABS-KEY ( diabetes  OR  glucose  OR  aspirin  OR  cardiovascular  OR  heart  OR  coronary  OR  “myocardial infarction”  OR  stroke  OR  colorectal  OR  colon  OR  breast  OR  cervical  OR  human  AND papillomavirus  OR  hpv  OR  diet  OR  exercise  OR  “physical activity”  OR  overweight  OR  obese  OR  obesity  OR  metabolic  OR  hypertension  OR  “blood pressure”  OR  lung  OR  tobacco  OR  smoke*  OR  smoking ) ) ) )  AND  ( TITLE-ABS-KEY ( “United States”  OR  usa  OR  “u.s.”  OR  alabama  OR  alaska  OR  arizona  OR  arkansas  OR  california  OR  colorado  OR  connecticut  OR  delaware  OR  “District of Columbia”  OR  florida  OR  georgia  OR  hawaii  OR  idaho  OR  illinois  OR  indiana  OR  iowa  OR  kansas  OR  kentucky  OR  louisiana  OR  maine  OR  maryland  OR  massachusetts  OR  michigan  OR  minnesota  OR  mississippi  OR  missouri  OR  montana  OR  nebraska  OR  nevada  OR  “New Hampshire”  OR  “New Jersey”  OR  “New Mexico”  OR  “New York”  OR  “North Carolina”  OR  “North Dakota”  OR  ohio  OR  oklahoma  OR  oregon  OR  pennsylvania  OR  “Rhode Island”  OR  “South Carolina”  OR  “South Dakota”  OR  tennessee  OR  texas  OR  utah  OR  vermont  OR  virginia  OR  washington  OR  “West Virginia”  OR  wisconsin  OR  wyoming  OR  “Puerto Rico” ) ) …

3,424 document results

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25

TITLE-ABS-KEY ( “United States”  OR  usa  OR  “u.s.”  OR  alabama  OR  alaska  OR  arizona  OR  arkansas  OR  california  OR  colorado  OR  connecticut  OR  delaware  OR  “District of Columbia”  OR  florida  OR  georgia  OR  hawaii  OR  idaho  OR  illinois  OR  indiana  OR  iowa  OR  kansas  OR  kentucky  OR  louisiana  OR  maine  OR  maryland  OR  massachusetts  OR  michigan  OR  minnesota  OR  mississippi  OR  missouri  OR  montana  OR  nebraska  OR  nevada  OR  “New Hampshire”  OR  “New Jersey”  OR  “New Mexico”  OR  “New York”  OR  “North Carolina”  OR  “North Dakota”  OR  ohio  OR  oklahoma  OR  oregon  OR  pennsylvania  OR  “Rhode Island”  OR  “South Carolina”  OR  “South Dakota”  OR  tennessee  OR  texas  OR  utah  OR  vermont  OR  virginia  OR  washington  OR  “West Virginia”  OR  wisconsin  OR  wyoming  OR  “Puerto Rico” ) …

4,938,292 document results

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24

( ( ( ( ( TITLE-ABS-KEY ( ( health  OR  healthcare  OR  “health care”  OR  care )  AND  ( equit*  OR  disparit*  OR  inequal*  OR  accessibilit* ) ) )  OR  ( ( TITLE-ABS-KEY ( equit*  OR  disparit*  OR  inequal*  OR  accessibilit* ) )  AND  ( ( TITLE-ABS-KEY ( socioeconomic  OR  economic  OR  poor  OR  vulnerable  OR  disenfranchis*  OR  “social class” ) )  OR  ( TITLE-ABS ( divers*  OR  minorit*  OR  ethnicit*  OR  race  OR  racial  OR  black*  OR  “african american*”  OR  asian*  OR  “native american*”  OR  indian  OR  hispanic  OR  latin* ) )  OR  ( TITLE-ABS ( disabled  OR  challenged  OR  handicapped ) )  OR  ( TITLE-ABS-KEY ( “cultural competency”  OR  “cultural diversity” ) )  OR  ( TITLE-ABS ( “sexual W/3 minorit*”  OR  homosexual*  OR  bisexual*  OR  gay*  OR  lesbian*  OR  transgender*  OR  queer  OR  lbg* ) ) ) ) ) )  AND  ( ( TITLE-ABS-KEY ( preventive  OR  prevention  OR  prevent ) )  OR  ( TITLE-ABS-KEY ( screen* ) )  OR  ( TITLE-ABS-KEY ( “United States Preventive Services Task Force”  OR  “U.S. Preventive Services Task Force”  OR  “U.S.P.S.T.F.”  OR  “USPSTF” ) ) ) )  AND  ( TITLE-ABS-KEY ( diabetes  OR  glucose  OR  aspirin  OR  cardiovascular  OR  heart  OR  coronary  OR  “myocardial infarction”  OR  stroke  OR  colorectal  OR  colon  OR  breast  OR  cervical  OR  human  AND papillomavirus  OR  hpv  OR  diet  OR  exercise  OR  “physical activity”  OR  overweight  OR  obese  OR  obesity  OR  metabolic  OR  hypertension  OR  “blood pressure”  OR  lung  OR  tobacco  OR  smoke*  OR  smoking ) ) ) …

8,651 document results

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23

TITLE-ABS-KEY ( diabetes  OR  glucose  OR  aspirin  OR  cardiovascular  OR  heart  OR  coronary  OR  “myocardial infarction”  OR  stroke  OR  colorectal  OR  colon  OR  breast  OR  cervical  OR  human  AND papillomavirus  OR  hpv  OR  diet  OR  exercise  OR  “physical activity”  OR  overweight  OR  obese  OR  obesity  OR  metabolic  OR  hypertension  OR  “blood pressure”  OR  lung  OR  tobacco  OR  smoke*  OR  smoking )

4,168,192 document results

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22

( ( ( TITLE-ABS-KEY ( ( health  OR  healthcare  OR  “health care”  OR  care )  AND  ( equit*  OR  disparit*  OR  inequal*  OR  accessibilit* ) ) )  OR  ( ( TITLE-ABS-KEY ( equit*  OR  disparit*  OR  inequal*  OR  accessibilit* ) )  AND  ( ( TITLE-ABS-KEY ( socioeconomic  OR  economic  OR  poor  OR  vulnerable  OR  disenfranchis*  OR  “social class” ) )  OR  ( TITLE-ABS ( divers*  OR  minorit*  OR  ethnicit*  OR  race  OR  racial  OR  black*  OR  “african american*”  OR  asian*  OR  “native american*”  OR  indian  OR  hispanic  OR  latin* ) )  OR  ( TITLE-ABS ( disabled  OR  challenged  OR  handicapped ) )  OR  ( TITLE-ABS-KEY ( “cultural competency”  OR  “cultural diversity” ) )  OR  ( TITLE-ABS ( “sexual W/3 minorit*”  OR  homosexual*  OR  bisexual*  OR  gay*  OR  lesbian*  OR  transgender*  OR  queer  OR  lbg* ) ) ) ) ) )  AND  ( ( TITLE-ABS-KEY ( preventive  OR  prevention  OR  prevent ) )  OR  ( TITLE-ABS-KEY ( screen* ) )  OR  ( TITLE-ABS-KEY ( “United States Preventive Services Task Force”  OR  “U.S. Preventive Services Task Force”  OR  “U.S.P.S.T.F.”  OR  “USPSTF” ) ) )

44,032 document results

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21

TITLE-ABS-KEY ( “United States Preventive Services Task Force”  OR  “U.S. Preventive Services Task Force”  OR  “U.S.P.S.T.F.”  OR  “USPSTF” )

2,244 document results

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20

TITLE-ABS-KEY ( screen* )

1,659,134 document results

Set alert Save this search Edit this search Delete this search

19

TITLE-ABS-KEY ( preventive  OR  prevention  OR  prevent )

2,221,984 document results

Set alert Save this search Edit this search Delete this search

18

( ( TITLE-ABS-KEY ( ( health  OR  healthcare  OR  “health care”  OR  care )  AND  ( equit*  OR  disparit*  OR  inequal*  OR  accessibilit* ) ) )  OR  ( ( TITLE-ABS-KEY ( equit*  OR  disparit*  OR  inequal*  OR  accessibilit* ) )  AND  ( ( TITLE-ABS-KEY ( socioeconomic  OR  economic  OR  poor  OR  vulnerable  OR  disenfranchis*  OR  “social class” ) )  OR  ( TITLE-ABS ( divers*  OR  minorit*  OR  ethnicit*  OR  race  OR  racial  OR  black*  OR  “african american*”  OR  asian*  OR  “native american*”  OR  indian  OR  hispanic  OR  latin* ) )  OR  ( TITLE-ABS ( disabled  OR  challenged  OR  handicapped ) )  OR  ( TITLE-ABS-KEY ( “cultural competency”  OR  “cultural diversity” ) )  OR  ( TITLE-ABS ( “sexual W/3 minorit*”  OR  homosexual*  OR  bisexual*  OR  gay*  OR  lesbian*  OR  transgender*  OR  queer  OR  lbg* ) ) ) ) )

357,715 document results

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17

( TITLE-ABS-KEY ( equit*  OR  disparit*  OR  inequal*  OR  accessibilit* ) )  AND  ( ( TITLE-ABS-KEY ( socioeconomic  OR  economic  OR  poor  OR  vulnerable  OR  disenfranchis*  OR  “social class” ) )  OR  ( TITLE-ABS ( divers*  OR  minorit*  OR  ethnicit*  OR  race  OR  racial  OR  black*  OR  “african american*”  OR  asian*  OR  “native american*”  OR  indian  OR  hispanic  OR  latin* ) )  OR  ( TITLE-ABS ( disabled  OR  challenged  OR  handicapped ) )  OR  ( TITLE-ABS-KEY ( “cultural competency”  OR  “cultural diversity” ) )  OR  ( TITLE-ABS ( “sexual W/3 minorit*”  OR  homosexual*  OR  bisexual*  OR  gay*  OR  lesbian*  OR  transgender*  OR  queer  OR  lbg* ) ) )

242,511 document results

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15

( TITLE-ABS-KEY ( socioeconomic  OR  economic  OR  poor  OR  vulnerable  OR  disenfranchis*  OR  “social class” ) )  OR  ( TITLE-ABS ( divers*  OR  minorit*  OR  ethnicit*  OR  race  OR  racial  OR  black*  OR  “african american*”  OR  asian*  OR  “native american*”  OR  indian  OR  hispanic  OR  latin* ) )  OR  ( TITLE-ABS ( disabled  OR  challenged  OR  handicapped ) )  OR  ( TITLE-ABS-KEY ( “cultural competency”  OR  “cultural diversity” ) )  OR  ( TITLE-ABS ( “sexual W/3 minorit*”  OR  homosexual*  OR  bisexual*  OR  gay*  OR  lesbian*  OR  transgender*  OR  queer  OR  lbg* ) )

6,920,422 document results

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13

TITLE-ABS-KEY ( equit*  OR  disparit*  OR  inequal*  OR  accessibilit* )

755,186 document results

Set alert Save this search Edit this search Delete this search

11

TITLE-ABS ( “sexual W/3 minorit*”  OR  homosexual*  OR  bisexual*  OR  gay*  OR  lesbian*  OR  transgender*  OR  queer  OR  lbg* )

85,555 document results

Set alert Save this search Edit this search Delete this search

9

TITLE-ABS-KEY ( “United States Preventive Services Task Force”  OR  “U.S. Preventive Services Task Force”  OR  “U.S.P.S.T.F.”  OR  “USPSTF” )

 

8

TITLE-ABS-KEY ( “cultural competency”  OR  “cultural diversity” )

5

TITLE-ABS ( disabled  OR  challenged  OR  handicapped )

4

TITLE-ABS ( divers*  OR  minorit*  OR  ethnicit*  OR  race  OR  racial  OR  black*  OR  “african american*”  OR  asian*  OR  “native american*”  OR  indian  OR  hispanic  OR  latin* )

2

TITLE-ABS-KEY ( socioeconomic  OR  economic  OR  poor  OR  vulnerable  OR  disenfranchis*  OR  “social class” )

1

TITLE-ABS-KEY ( ( health  OR  healthcare  OR  “health care”  OR  care )  AND  ( equit*  OR  disparit*  OR  inequal*  OR  accessibilit* ) )

Cochrane

#1           ((health or healthcare or “health care” or care) and (equit* or disparit* or inequal* or accessibilit*)):ti,ab,kw

#2           (socioeconomic or economic or poor or vulnerable or disenfranchis* or “social class”):ti,ab, kw

#3           (divers* or minorit* or ethnicit* or race or racial or black* or “african american*” or asian* or “native american*” or indian or hispanic or latin*):ti,ab,kw

#4           (disabled or challenged or handicapped):ti,ab,kw

#5           (“sexual near/3 minorit*” or homosexual* or bisexual* or gay* or lesbian* or transgender* or queer or lbg*):ti,ab,kw

#6           (“cultural competency” or “cultural diversity”):ti,ab,kw

#7           #2 OR #3 OR #4 OR #5 OR #6

#8           #7 AND (equit* or disparit* or inequal* or accessibilit*):ti,ab,kw

#9           #1 OR #8

#10        (preventive or prevention or prevent):ti,ab,kw

#11        screen*:ti,ab,kw

#12        (“United States Preventive Services Task Force” or “U.S. Preventive Services Task Force” or “U.S.P.S.T.F.” or “USPSTF”):ti,ab,kw

#13        #9 AND ( #10 OR #11 OR #12)

#14        (diabetes or glucose or aspirin or cardiovascular or heart or coronary or “myocardial infarction” or stroke or colorectal or colon or breast or cervical or human papillomavirus or HPV or diet or exercise or “physical activity” or overweight or obese or obesity or metabolic or hypertension or “blood pressure” or lung or tobacco or smoke* or smoking):ti,ab,kw

#15        #13 AND #14

#16        ( “United States”  OR  usa  OR  “u.s.”  OR  alabama  OR  alaska  OR  arizona  OR  arkansas  OR  california  OR  colorado  OR  connecticut  OR  delaware  OR  “District of Columbia”  OR  florida  OR  georgia  OR  hawaii  OR  idaho  OR  illinois  OR  indiana  OR  iowa  OR  kansas  OR  kentucky  OR  louisiana  OR  maine  OR  maryland  OR  massachusetts  OR  michigan  OR  minnesota  OR  mississippi  OR  missouri  OR  montana  OR  nebraska  OR  nevada  OR  “New Hampshire”  OR  “New Jersey”  OR  “New Mexico”  OR  “New York”  OR  “North Carolina”  OR  “North Dakota”  OR  ohio  OR  oklahoma  OR  oregon  OR  pennsylvania  OR  “Rhode Island”  OR  “South Carolina”  OR  “South Dakota”  OR  tennessee  OR  texas  OR  utah  OR  vermont  OR  virginia  OR  washington  OR  “West Virginia”  OR  wisconsin  OR  wyoming  OR  “Puerto Rico” )

#17        #15 AND #16

July 2019 thru Nov 2021

Freeman HP, Rodriguez RL. History and principles of patient navigation. Cancer 2011;117(S15):3537-40.

Nelson HD, Cantor A, Wagner J et al. Effectiveness of patient navigation to increase cancer screening in populations adversely affected by health disparities: a meta-analysis. Journal of General Internal Medicine 2020;35(10):3026-35.

Sabatino SA, Thompson TD, White MC et al. Cancer screening test receipt – United States, 2018. MMWR 2021;70(2):29-35.

U.S. Preventive Services Task Force (USPSTF). Breast cancer: screening. Bethesda (MD): 2016. Accessed June 15, 2022. www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening

USPSTF. Cervical cancer: screening. Bethesda (MD): 2018. Accessed June 15, 2022. URL: www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening

USPSTF. Colorectal cancer: screening. Bethesda (MD): 2021. Accessed June 15, 2022. www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening

Evidence from the systematic review suggests patient navigation services adjusted to fit local needs and resources can increase cancer screenings among people from historically disadvantaged racial or ethnic groups and people with lower incomes. Evidence suggests programs with different intervention characteristics implemented in different settings will be effective.

• Patient navigation services examined in this review were delivered by a wide array of deliverers, including CHWs, trained lay patient or professional navigators, nurses, case managers, or clinic staff. Delivery may be enhanced when deliverers have local knowledge, provide language-appropriate and culturally competent services, have flexible working hours to better fit patients’ schedules, and work closely with healthcare providers.
• Patient navigation services can be delivered remotely, which might help in rural areas or other settings where transportation is difficult. Programs may combine face-to-face and remote interactions based on the unique needs of the delivers and patients.
• Patient navigation services can be provided at every step along the cancer continuum to guide patients through the healthcare system and reduce cancer mortality, and in some cases incidence.

Evidence-Based Cancer Control Programs (EBCCP)

Find programs from the EBCCP website that align with this systematic review. (What is EBCCP?)

Healthy People 2030

Healthy People 2030 includes the following objectives related to this CPSTF recommendation.

• Reduce the colorectal cancer death rate — C-06
• Increase the proportion of adults who get screened for colorectal cancer — C-07