Patient Navigation Program Improves Colonoscopy Completion Rates After Abnormal FIT Results
The phone-based patient navigation intervention addressed barriers to CRC testing follow-up and included patient education.
A targeted patient navigation program significantly increased colonoscopy completion rates within 1 year among individuals with abnormal fecal immunochemical test (FIT) results, according to findings recently published in Annals of Internal Medicine. Study participants in a federally qualified health center (FQHC) who received telephone-based navigation support were 69% more likely to undergo a recommended follow-up colonoscopy within 12 months than those who received usual care (adjusted OR 1.69; 95% CI, 1.3-2.19).1
The finding reflects the 13 percentage point gap between the proportion of each group that followed through with the procedure within the 12 month period (55.1% vs 42.1%; [95% CI, 6.5 to 19.4]).1
Current colonoscopy completion rates in many healthcare settings fall well below the 80% target established by the US Multi-Society Task Force on Colorectal Cancer,2 with rates as low as 18% in some federally qualified health centers,3 lead author Gloria D. Coronado, PhD, associate director of population science and professor of public health at University of Arizona Cancer Center, and colleagues noted. The team hypothesized that the proposed intervention, compared with usual care, would improve the rates of follow-up testing.
The PRECISE (Predicting and Addressing Colonoscopy non-Adherence in Community Settings) study enrolled 985 adults aged 50 to 75 years who had received an abnormal FIT result in the previous month at Sea Mar Community Health Centers, a FQHC operating 32 clinics in western Washington. The final cohort for the primary analysis comprised 967 participants who were randomly assigned to the patient navigation group (479) or to usual care (488). Mean age of the group was 61 years and 46% were women, according to the study.
Those in the navigation group participated in a 6-topic telephone-based program designed to identify and offer solutions to common barriers to follow-up, eg insurance coverage, transportation, as well as to provide education on the procedure and interpreting results (see Figure below). All navigators were fluent in English and Spanish, authors noted, as 18% of participants indicated a preference for the latter. Navigators made up to 6 attempts for each scheduled call.
FINDINGS
The researcher's modified intention-to-treat analysis found that approximately half (55.1%; 95% CI, 50.3% to 59.7%) of the intervention group and 42.1% (95% CI, 37.5% to 46.8%) of the usual care group had a colonoscopy procedure within 12 months. Coronado and colleagues reported that navigation program participants were 69% more likely to undergo colonoscopy than those who experienced usual care (adjusted OR 1.69; 95% CI, 1.3-2.19).1
Looking at the secondary outcomes, the team found that of the final 242 participants who received the navigation intervention, 94% completed a colonoscopy within 12 months. The intervention group also completed the recommended colonoscopy more quickly than the usual care group, with mean time to the procedure of 229 days (95% CI, 217-241) for the former vs 256 days (95% CI, 224-268), for the latter.
Among the 471 participants who completed a colonoscopy within 12 months across both study conditions, nearly half (225, 47.8%) had a low-risk adenoma, 64 (13.6%) had an advanced adenoma, and 7 (1.5%) were found to have cancer, results underscoring the importance of timely completion of screening for colorectal cancer, authors wrote.1
Among the 242 study participants who received the allocated navigation intervention, nearly all (94.2%) completed their colonoscopy procedure, compared with 14.4% among the 247 who did not, demonstrating the significant value of patient navigation for those who can be contacted and agree to services. This point underscores the challenges with an intervention like this, the authors said, noting that 20.3% of patients could not be contacted or were lost to follow-up, and an additional 29.7% did not receive navigation for various reasons including declining participation, ineligibility, or transferring care.1
They do note, as well, that interpretation of the findings must consider the context of the study, which took place during the COVID-19 pandemic. The effectiveness of the program was likely affected by care suspensions for social distancing, policy changes, high navigator turnover, and patient hesitancy.
Looking toward the future, Coronado et al suggested several strategies with potential to enhance patient navigation programs, including establishing a national quality measure for colonoscopy follow-up, implementing prioritized scheduling approaches for high-risk patients, and exploring novel care models that co-locate gastroenterology providers in community health centers.
They also cautioned that long-term viability of patient navigation will depend on securing adequate and reliable funding. While the White House mandated reimbursement for navigation services for patients with a cancer diagnosis in 2023, it did not address navigation for screening or follow-up after an abnormal test result.4
