Patient navigation may improve colonoscopy completion following abnormal stool test

1. In this randomized controlled trial, participants with an abnormal fecal immunochemical test who received patient navigation had higher rates of subsequent colonoscopy than those who received usual care.

2. The mean time to colonoscopy was also shorter in the patient navigation group than in the usual care group.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Fecal immunochemical testing (FIT) is a recommended form of colorectal cancer (CRC) screening. The United States Multi-Society Task Force on Colorectal Cancer established an 80% target for follow-up colonoscopy completion, but many healthcare settings have faced significant barriers reaching this benchmark. When identified early, CRC is one of the most treatable forms of cancer but delays in diagnosis can have detrimental effects due to the high morbidity and mortality associated with late-stage disease. Meta-analyses have shown significantly improved screening rates overall in individuals who receive navigation, but there have been limited prospective trials investigating rates of colonoscopy follow-up specifically after an abnormal screening test. Hence, this randomized controlled trial evaluated whether patient navigation delivered to individuals with an abnormal FIT test increased follow-up colonoscopy completion at 1 year compared to those who received usual care outreach. Overall, the study found that participants with abnormal screening results who were assigned to patient navigation had higher rates of colonoscopy than those who received usual care. This effect appeared to be consistent across all prespecified subgroups, including age, sex, language, and insurance status. The mean time to colonoscopy was also shorter in the navigation group than in the usual care group. Notably, approximately half of the intervention group did not actually receive navigation for various reasons, reflecting the challenges surrounding the CRC screening landscape. Further, the study was conducted during the COVID-19 pandemic and thus, its results were impacted by additional barriers to colonoscopy at the patient and system levels. Nonetheless, these results demonstrated that patient navigation was associated with greater receipt of follow-up colonoscopy after abnormal FIT.

Click to read the study in AIM

Relevant Reading: Development of a follow-up measure to ensure complete screening for colorectal cancer

In-Depth [randomized controlled trial]: This randomized controlled trial, titled PRECISE (Predicting and Addressing Colonoscopy non-Adherence in Community Settings), investigated the efficacy of patient navigation in increasing rates of colonoscopy follow-up in individuals with abnormal FIT screening. The study was conducted at a large federally qualified health center which serves approximately 220,000 patients in Washington. The navigation intervention covered 6 topics: introduction and barrier assessment, barrier resolution, bowel preparation instruction, bowel preparation reminder, colonoscopy procedure check-in, and understanding of colonoscopy result and retesting interval. A total of 967 patients between 50 and 75 years of age with an abnormal FIT result were randomly assigned in a 1:1 ratio to the navigation or usual care group (479 and 488 patients, respectively). The mean age of participants was 61 years. In a modified intention-to treat analysis, 55.1% (95% confidence interval [CI], 50.3% to 59.7%) of individuals in the navigation group received a colonoscopy within 12 months compared to 42.1% (95% CI, 37.5% to 46.8%) in the usual care group (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). Navigation increased follow-up colonoscopy by 2.7%, 15.5%, and 14.8% in the groups with low-, moderate-, and high-probability of follow-up colonoscopy receipt. Mean time to colonoscopy was 229 days (95% CI, 217 to 241 days) in the navigation group versus 256 days (95% CI, 244 to 268 days) in the usual care group. In summary, this study showed that patient navigation increased follow-up colonoscopy completion in individuals with abnormal FIT results compared to usual care.

Image: PD

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