Precision Patient Navigation to Improve Rates of Follow-up Colonoscopy, An Individual Randomized Effectiveness Trial

Area of Science:

• Oncology
• Preventive Medicine
• Health Services Research

Background:

• Colorectal cancer (CRC) screening via annual fecal immunochemical test (FIT) is cost-effective but faces low follow-up colonoscopy adherence after abnormal results.
• Patient navigation may improve adherence for high-risk individuals who are unlikely to complete follow-up procedures.

Purpose of the Study:

• To evaluate the effectiveness of targeted patient navigation in improving follow-up colonoscopy adherence among patients with abnormal CRC screening results.

Main Methods:

• A randomized trial involving 415 patients (ages 50-75) with abnormal FIT results and predicted low adherence (<70%) was conducted.
• Participants were randomized to receive either patient navigation or usual care, stratified by adherence probability.
• Colonoscopy completion within 6 months was compared between groups using Cox proportional hazards regression.

Main Results:

• Patient navigation resulted in a significantly higher colonoscopy completion rate (76%) compared to usual care (65%) within 6 months (HR=1.35, P=0.027).
• The study included a diverse patient population with a mean age of 62, 54% female, and 87% non-Hispanic white.

Conclusions:

• Targeted patient navigation effectively improves adherence to recommended follow-up colonoscopies after abnormal colorectal cancer screening.
• Further research is warranted to assess the long-term impact and value of precision-directed navigation programs in cancer care.