Patient navigators improve colonoscopy rates after abnormal stool tests, study shows

TUCSON, Arizona — A University of Arizona Health Sciences-led study found that patients are more likely to get colonoscopies following abnormal stool test results if patient navigators assist them through the process.

The paper, published in the Annals of Internal Medicine, showed that 55% of patients who were assigned to a patient navigator received follow-up colonoscopies within a year compared with 42.5% of patients who received usual care without a navigator.

“It is important for patients with abnormal stool test results to get a colonoscopy as soon as possible to prevent an increased risk of colorectal cancer and later-stage cancer detection,” said first author Gloria Coronado, PhD, the U of A Cancer Center’s associate director of population science and a professor at the U of A Mel and Enid Zuckerman College of Public Health. “We found that using patient navigators improved rates of colonoscopy follow-up and reduced time to follow-up among patients who had an abnormal fecal immunochemical test, or FIT test. This guidance through the process can improve patient survival rates through earlier cancer detection.”

Patients ranging in age from 50 to 75 who had abnormal fecal test results in the prior month were enrolled in PRECISE, which stands for Predicting and Addressing Coloscopy Non-Adherence in Community Settings. All of the patients were seen at Sea Mar Community Health Centers, a federally qualified health center that operates 32 clinics in western Washington.

A total of 970 patients with abnormal FIT results were enrolled, and 479 were randomly selected and assigned to a patient navigator on staff at Sea Mar. Patients not assigned to a navigator received usual care consisting of up to two phone calls and a letter to schedule a colonoscopy appointment.

Patient navigators sent introductory letters, made phone calls and delivered text messages to patients addressing six topic areas at scheduled times: introduction and barrier assessment, barrier resolution, bowel preparation instructions, bowel preparation reminder, colonoscopy check-in and a final checkup following the completed procedure. Navigators made up to six attempts for each scheduled call, and patients not initially reached were called up to 12 more times and sent a follow-up letter.

Patient navigation resulted in a 12% improvement in one-year follow-up colonoscopy completion rates over usual care. Additionally, patients allocated to navigation obtained a colonoscopy in an average of 229 days, which was 27 days shorter than usual care patients.

Coronado said the colorectal cancer mortality rate could be substantially reduced if patients with abnormal stool test results received timely follow-up colonoscopies, as patients who delay are seven times more likely to die from colorectal cancer.

In the future, Coronado said her team hopes clinics will use navigators for patients who receive an abnormal stool test result.

“By standardizing navigation, clinics can establish procedures that include notifying patients of their results and assisting them in understanding the importance of a colonoscopy,” Coronado said.

According to the American Cancer Society, colorectal cancer is the third-leading cause of cancer-related deaths in U.S. men and the fourth-leading cause in U.S. women, but it’s the second most common cause of cancer deaths when numbers for men and women are combined.

This study was supported by the National Cancer Institute, a division of the National Institutes of Health, under award no. 5R01CA218923.