Mailed FIT plus bilingual navigator program screened young, diverse patient population

A multimodal, bilingual program succeeded in getting a significant proportion of patients ages 45 to 49 years to complete a mailed fecal immunochemical test (FIT), a recent study found.

The study reported on a quality improvement program at one hospital-based primary care clinic targeting patients ages 45 to 49 years who were eligible for colorectal cancer screening (CRC) but not up to date on it. The intervention began with a mailed or portal message in English and Spanish addressing health beliefs about CRC screening (perceived susceptibility, severity, benefits, and barriers) and informing patients that a FIT would be mailed unless they opted out. If patients did not return the mailed FIT within 10 days, they were called by a health navigator; all Spanish-speaking patients were assigned a bilingual navigator, allowing for language-concordant and culturally aligned communication. After two weeks, reminder letters were sent.

Of the 589 patients who received mailed FITs, 24% returned a completed test. A higher percentage of Hispanic patients returned their FITs rates than non-Hispanic patients (29% vs. 21%). Only 12% of Black patients returned their tests. The navigation steps increased return rates—an additional 8% of patients returned their FIT after the phone call and another 9% did so after the reminder letter. Overall, 11 FITs were positive (8%). Eight patients (73%) had a follow-up colonoscopy and three were found to have advanced adenomas. The study results were published by the Journal of General Internal Medicine on Dec. 8.

“The results of this quality improvement project underscore the significant impact that multi-modal navigation services can have to improve FIT return rates in patients aged 45–49, particularly among Hispanic populations,” the study authors said.

They noted that the navigators stayed involved after positive FITs, helping to ensure colonoscopy completion by working with patients to overcome transportation challenges by connecting them with vouchers provided through social work, public transportation options, or “culturally sensitive alternatives” such as community carpools. “By tackling patient, clinic, and system-level obstacles, this culturally tailored navigation can enhance care quality and advance health equity, particularly in safety-net settings, addressing social determinants of health and reducing disparities in CRC care,” the authors wrote.