Patient navigation enhances the completion of follow-up colonoscopy

Patient navigation was more effective than usual care in increasing follow-up colonoscopy rates after abnormal stool test results, a new randomized controlled trial revealed.

This intervention resulted in a significant increase in the completion of follow-up colonoscopy over the course of 1 year compared to regular care (55.1% vs. 42.1%). It's published online in Internal Medicine Chronicles.

“We can see that patients with abnormal fecal test results are about a twenty-thousand chances of colorectal cancer being discovered and that there are advanced adenomas that can be removed to prevent cancer.” Medscape Medical News.

“It's important for these patients to have a follow-up colonoscopy,” she said. “Patient navigation can achieve this goal.”

“Very effective” intervention

The researchers compared the effectiveness of patient navigation programs to the effectiveness of normal care outreach in increasing follow-up colonoscopy after abnormal stool testing. They also developed a risk prediction model that calculates the probability of patients undergoing follow-up colonoscopy without navigation to determine whether this additional intervention has a significant impact on what was deemed to be less likely to follow-through.

The study included 967 patients from Washington's Community Health Center who had undergone abnormal fecal test results within the previous month. The average age of participants was 61 years old, about 45% were female, 77% were white, and 18% preferred Spanish interventions. In total, 479 patients received intervention and 488 patients received normal care.

The intervention was delivered by patient navigators who mailed introductory books, texted them, and made a live call. In the call, the navigator addressed topics of barrier assessment and resolution, intestinal preparation instructions and reminders, colonoscopy check-in, and colonoscopy results and retest interval.

Patients in the regular care group were contacted by the referral coordinator and scheduled appointments for follow-up colonoscopy. If initially unreached, up to two follow-up attempts were made 30 and 45 days after the date of referral.

Patient navigation increased significantly by 13% in follow-up, with people in this group completing colonoscopy 27 days earlier than the usual care group (mean, 229 days vs. 256 days).

Contrary to the author's expectations, the efficacy of the intervention was not altered by the patient's predicted chances of undergoing colonoscopy without navigation.

In particular, 20.3% of patients were lost due to unreachable or follow-up, and 29.7% were not navigational. Of the 479 patients assigned to navigation, 79 (16.5%) reduced participation, not reaching 56 (11.7%).

This study was primarily conducted at the height of the Covid-19 pandemic, creating additional systemic and personal barriers to completing colonoscopy.

Nevertheless, the authors wrote, “Our findings suggest that patient navigation is highly effective in patients eligible for colonoscopy.”

“Most patients that reached were contacted with fewer than six phone attempts,” Coronado noted. “Determining how to reach and motivate patients requires more effort. [who did not participate] To get a follow-up colonoscopy. ”

Coronado and her colleagues are looking for ways to leverage artificial intelligence and a virtual approach to enhance patient navigation programs. For example, use virtual navigators or low-cost automated tools to provide education to build confidence in colonoscopy patients.

“A promising tool”

“Completing colonoscopy after a stool-positive, sclerosis-based test is important to alleviate the effects of colon cancer,” commented Rajiv Bhuta, MD, assistant professor of clinical gastrointestinal science and hepatics at Lewis Katz School of Medicine in Philadelphia, who was not involved in the study. “While previous studies evaluating navigation have demonstrated improvements, none have been registered or generalizable as in the current study.”

That being said, Bhuta said Medscape Medical News This study may have provided details about coordination and communication with local gastrointestinal practices.

“Local ordering and prescribing practices differ and can have a significant impact on compliance rates. Was the colonoscopy completed via an open access route, or did the patient need to see a gastroenterologist first?

He also said that several aspects of the study (such as access to tax-reducing professional care and free ride services) could limit generalizable restrictions to the setting without such resources.

He said, “Patient Navigators for Cancer Treatment require refunds, but there are no current refunds for Navigators of Abnormal Screening Tests.

Bhuta said the dropout rate in this study reflects the dropout rate of his own real-world practices.

“I would especially like to see research that provides behavioral insights about why patients respond positively to navigation. It is due to reminders, emotional support, or logistical support. Is it a systematic barrier, is it a patient indifference or promotes non-conflict?”

Despite these uncertainties and the need to improve implementation logistics, Bhuta concluded: “This strategy is a promising tool to reduce disparity and improve colorectal cancer outcomes. Clinicians should advocate or implement structured follow-up systems, particularly in high-risk populations.”

This study was funded by the National Cancer Institute. Coronado received a grant/contract from Garden Health. Bhuta declared no related conflicts of interest.

Marilyn Larkin, Massachusetts is an award-winning medical writer and editor, and has appeared in many publications, including Medscape Medical News and its sister publication Mdedge. Rancet (She was a contributing editor), Reuters Health.