Sara Kellner , 2025-04-17 11:00:00
April 17, 2025
2 min read
Key takeaways:
- A patient navigation program addressed barriers to getting a colonoscopy, including insurance and transportation.
- Patients were 69% more likely to get a colonoscopy with patient navigation vs. usual care.
A patient navigation program significantly improved the odds that people would get a colonoscopy after receiving an abnormal fecal immunochemical test result, according to a study published in Annals of Internal Medicine.
Several factors prevent people from getting a colonoscopy, Gloria D. Coronado, PhD, associate director of population science and professor of public health at University of Arizona Cancer Center, told Healio. Instructions for preparation can be hard to follow, she said, and some clinics schedule months out. Having to take time off of work and getting someone to drive them home can also be barriers.
Data were derived from Coronado GD, et al. Ann Intern Med. 2025;doi:10.7326/ANNALS-24-01885.
Coronado and colleagues aimed to determine whether enhanced patient navigation could overcome some of these barriers and improve colonoscopy completion after an abnormal stool test.
They conducted a randomized controlled trial of 967 patients aged 50 to 75 years (mean age, 61 years; standard deviation, 6.8 years; 46% women) at Sea Mar Community Health Center, a federally qualified health center in Washington state. Eligible participants had an abnormal FIT result in the previous month.
Just over half of participants (n = 488) served as the control group receiving usual care, and the remaining 479 patients were assigned to the intervention group, which included participation in a six-topic, telephone-based patient navigation program. Some patients in the intervention group declined navigation or were unreachable, leaving 242 patients (49.5%) in the intervention group.
“Usual care focuses on making the referral and encouraging the patient to schedule the procedure,” she said. “Patient navigation is focused on identifying and addressing barriers that patients face.”
In this study, clinic staff talked patients through steps of the procedure and also offered help enrolling in insurance or arranging transportation to and from the procedure. All of the assigned navigators were fluent in English and Spanish, since 18% of the cohort preferred Spanish, according to their medical records.
According to modified intention-to-treat analysis, 55.1% (95% CI, 50.3% to 59.7%) of patients in the intervention group and 42.1% (95% CI, 37.5% to 46.8%) in the control group underwent colonoscopy within 12 months, according to the researchers. Results also showed that those who participated in patient navigation were 69% more likely to get a colonoscopy than those who did not (adjusted OR = 1.69; 95% CI, 1.3-2.19).
Of the 242 participants assigned to patient navigation, 94% received a colonoscopy within 12 months, Coronado and colleagues wrote. Patients in the intervention group also underwent colonoscopy earlier than those in the control group (mean time, 229 days; 95% CI, 217-241; vs. mean, 256 days; 95% CI, 224-268).
More than half of the 471 patients who received a colonoscopy were diagnosed with low-risk adenoma (47.8%) or advanced adenoma (13.6%), and seven patients were diagnosed with cancer, according to the researchers.
“While new screening tests, including blood tests, are gaining FDA approval in the United States, it is important to note that all non-colonoscopic screening tests must be followed by a colonoscopy in order to achieve the benefits of screening,” Coronado said. “Patient education on the need for follow-up colonoscopy will become even more important.”
Coronado foresees AI becoming more common in CRC screening in the future.
“It is possible that patient education components of navigation can be accomplished through a virtual navigator,” she said. “I think this is exciting.”
For more information:
Gloria D. Coronado, PhD, can be reached at gdcoronado@arizona.edu.
Sources/Disclosures
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Disclosures:
Coronado reports receiving grants or contracts from Guardant Health outside the submitted work. The other authors report no relevant financial disclosures.