Enhancing Colonoscopy Follow-Up Rates Through Patient Navigators

A recent study led by researchers at the University of Arizona Health Sciences has revealed that the involvement of patient navigators can significantly boost the rates of colonoscopy follow-ups after patients receive abnormal results from stool tests.

Published in the Annals of Internal Medicine, the research found that 55% of patients who were assigned a patient navigator underwent colonoscopy within a year, in contrast to just 42.5% of those who received standard care without navigator assistance.

According to the study, timely follow-up colonoscopies are crucial for patients with abnormal stool test results to mitigate the risk of developing colorectal cancer or facing later-stage cancer diagnoses. The first author noted that enhanced support through patient navigation not only improved follow-up rates but also reduced the time taken for patients to schedule and complete their colonoscopies.

The study involved patients aged 50 to 75 who had received abnormal results from fecal immunochemical tests (FIT) within the last month. Participants were enrolled in a program called PRECISE (Predicting and Addressing Colonoscopy Non-Adherence in Community Settings) at Sea Mar Community Health Centers, which operates multiple clinics across western Washington.

Out of 970 patients with abnormal FIT results, 479 were randomly selected to receive assistance from a dedicated patient navigator, while the remaining participants were offered standard care, which included up to two phone calls and a letter inviting them to schedule a colonoscopy.

The patient navigators engaged with patients through introductory letters, phone calls, and text messages, covering six critical areas: introducing themselves, assessing barriers to follow-up, providing bowel preparation instructions, sending reminders, assisting with check-in for the procedure, and conducting follow-ups post-colonoscopy.

Each navigator made several attempts to reach patients, with up to 12 additional calls and follow-up letters sent to those who were not initially reachable. This approach led to a notable 12% increase in the completion rates of colonoscopies after one year compared to standard care. Additionally, patients who received navigation completed their procedures in an average of 229 days, which is 27 days sooner than those who did not have navigational support.

The researchers emphasized that the colorectal cancer mortality rate could be significantly lowered if patients with abnormal stool test results were provided timely access to follow-up colonoscopies. Delays in receiving these follow-ups can increase the likelihood of mortality from colorectal cancer by seven times.

Looking forward, the research team hopes that medical facilities will adopt patient navigator programs for individuals receiving abnormal stool test results. By implementing standardized navigation protocols, clinics can enhance their procedures for notifying patients of test results and helping them understand the critical nature of follow-up colonoscopies.

In light of the American Cancer Society's findings that colorectal cancer ranks as the third leading cause of cancer-related deaths in men and fourth in women in the United States, it is imperative to address barriers to timely screenings and follow-ups.