Patient navigation improves colonoscopy completion at 1 year, study finds
Rates of follow-up colonoscopy in a U.S. study were higher in patients assigned to receive telephone-based navigation after an abnormal stool test versus usual care.
Patients who received telephone-based navigation after an abnormal result on a fecal immunochemical test (FIT) were more likely to complete follow-up colonoscopy, a recent study found.
Researchers at a federally qualified health center in Washington state randomly assigned patients who had had an abnormal FIT result in the previous month to a patient navigation program for colonoscopy completion or to usual care. The patient navigation program was telephone-based, available in English and Spanish, and covered six topic areas: introduction and barrier assessment, barrier resolution, bowel preparation instruction, bowel preparation reminder, colonoscopy procedure check-in, and understanding of colonoscopy result and retesting interval. The primary outcome measure was receipt of follow-up colonoscopy at one year. Secondary outcomes were time to colonoscopy receipt and program effectiveness. The results were published April 1 by Annals of Internal Medicine.
Nine hundred eighty-five patients were enrolled in the study, and 967 were included in the primary intention-to-treat analysis (479 in the patient navigation group and 488 in the usual care group). Mean age was 61 years, and approximately 18% reported a Spanish-language preference.
At one year, the patient navigation group had higher rates of follow-up colonoscopy compared with the usual care group (55.1% vs. 42.1%; risk difference, 13.0 percentage points [95% CI, 6.5 to 19.4 percentage points]; adjusted odds ratio, 1.69 [95% CI, 1.30 to 2.19]; P=0.001). Of the 242 participants who were assigned to the navigation group and received the intervention, 227 (94%) completed a follow-up colonoscopy. Mean time to colonoscopy was 229 days (95% CI, 217 to 241 days) in the intervention group and 256 days (95% CI, 244 to 268 days) in the usual care group. The effect of the intervention was not moderated by patients' probability of obtaining a colonoscopy without navigation.
Among other limitations, the time to colonoscopy completion was long and the study was done during the height of the COVID-19 pandemic, the authors noted. They concluded that patient navigation in a community health care setting resulted in a significant boost in rates of colonoscopy completion at one year versus usual care and said their findings support the effectiveness of patient navigation for this purpose.
Several initiatives could improve uptake of such programs, the authors said, including a national quality measure for colonoscopy follow-up, a prioritized scheduling approach for high-risk patients, and co-location of gastroenterology clinicians in community health center practices. In addition, “Ensuring adequate and reliable funding sources will be essential for these programs to reach their full potential,” they wrote. “This may require demonstrating the potential for cost savings achieved through downstaged [colorectal cancer] detection and a reduction in missed or canceled gastroenterology appointments.”