Patient Navigation to Improve Colonoscopy Completion After an Abnormal Stool Test Result : A Randomized Controlled Trial.

Abstract

Patient navigation is a recommended practice of the Guide to Community Preventive Services; little is known about whether it improves colonoscopy completion for adults who have received an abnormal stool test result. To determine whether patient navigation delivered to persons with an abnormal stool test result increased follow-up colonoscopy completion (primary) at 1 year. Randomized controlled trial. (ClinicalTrials.gov: NCT03925883). A federally qualified health center (<i>n</i> = 32 clinics) in Washington state. Persons aged 50 to 75 years with an abnormal fecal test result in the prior month. A 6-topic, telephone-based patient navigation program delivered by bilingual (English and Spanish) clinical staff. Receipt of follow-up colonoscopy at 1 year (primary); time to colonoscopy receipt (secondary); and program effectiveness by patient characteristics, including patients' probability of obtaining a colonoscopy without navigation, derived using health record data (secondary). Of 985 participants enrolled (mean age, 61 years [SD, 6.8]; 170 [18%] had a Spanish-language preference listed in the medical record), 967 were included in the primary intention-to-treat analysis (479 in patient navigation, 488 in usual care). Receipt of follow-up colonoscopy was higher in the patient navigation group than in the usual care group (55.1% vs. 42.1%; risk difference, 13.0 percentage points [95% CI, 6.5 to 19.4 percentage points]). The intervention effect was not moderated by patients' probability of obtaining a colonoscopy without navigation. The study was primarily done during the height of the COVID-19 pandemic, which created additional barriers to colonoscopy at the health system and patient levels. These findings support the effectiveness of patient navigation for follow-up colonoscopy completion. National Cancer Institute.