CP17 - A targeted patient navigation program for follow-up colonoscopy after abnormal fecal testing in a community health center setting

Poster Type: Research

Primary Funding Source: National Cancer Institute

Category: Expanding Access to Care and Other Services

Research Objectives: To test the effectiveness of a targeted patient navigation program for follow-up colonoscopy after an abnormal fecal test result in a community health center setting

Study Design/Methods: PRECISE is a patient-randomized trial of patient navigation vs usual care for follow-up colonoscopy that will enroll 1,200 patients across 28 community health center clinics (anticipated 37% Latinx). As part of the study, we trained a bilingual patient navigator using an intensive 8-week program, based on the New Hampshire Colorectal Cancer Screening Research Program. The program included multi-day trainings on CRC screening, colonoscopy, patient navigator skills, the phone-based navigation protocol, data tracking, motivational interviewing, script review, and in-person meetings with local gastroenterology offices. We present patient-reported barriers to follow-up colonoscopy and qualitative findings from interviews with patients who received navigation.

Principal Findings and Quantitative/Qualitative Results: To-date, 252 patients have been randomized (124 to navigation and 128 to usual care). Common barriers identified during navigation were lack of bowel preparation understanding (89%), fear of procedure or results (24%), appointment or preferred provider availability challenges (16%), not having a companion for the procedure (15%), and transportation (13%). Findings from 12 in-depth interviews with navigated patients (goal = 30) showed that patients reported great value in being able to easily access the navigator for questions and support during key timepoints, such as during bowel preparation; and would use the program again in the future if offered.

Conclusions on Impact on Health Centers: CRC screening by fecal immunochemical test (FIT) is an accessible and cost-effective strategy to lower CRC incidence and mortality. However, this mode of screening depends on follow-up colonoscopy after an abnormal FIT result to prevent CRC or find it in early, treatable forms. Unfortunately, half of patients with an abnormal FIT result fail to complete this essential screening component, due to patient and system-level barriers. Patient navigation can provide much needed support for patients to complete the follow-up colonoscopy. This innovative clinical trial highlights the importance of targeted patient navigation to improve CRC screening completion in community health centers.

Author(s):

Jamie Thompson, MPH, Senior Research Associate, Kaiser Permanente Center for Health Research

TO DOWNLOAD A PDF OF THIS POSTER, PLEASE VISIT THE RESOURCES TAB: