Multilevel challenges and adaptations to patient navigation programs for colorectal cancer screening and follow-up:...

Patient navigation services can substantially boost participation in colorectal cancer screening and follow-up. As part of the Accelerating Colorectal Cancer Screening and follow-up through Implementation Science (ACCSIS) consortium, this study describes facilitators, barriers, and context-specific adaptations to sustainably deliver navigation in diverse settings.

Qualitative interviews were conducted with patient navigators and ACCSIS research project team members between February and August 2024; interviews were recorded, transcribed, and analyzed via rapid methods.

Seventeen patient navigators and eight research project team members (from six research projects) were interviewed. The navigation programs varied in scope: supporting initial screenings, follow-ups for abnormal stool tests, or both. Common facilitators were training navigators via multiple teaching methods and integrating navigators directly into clinic teams. Common barriers were high staff turnover, lack of sustainable funding for navigator positions, limited clinic resources and inadequate electronic health record tools, difficulty in contacting patients, and problems in accessing endoscopy services. Common adaptations made to improve programs included providing gift bags or drop boxes to make stool testing more appealing to patients, adjusting how often and how navigators were trained, evaluating clinic and specialist capacity before implementation, allowing navigators to schedule colonoscopies directly, and establishing partnerships that reduced colonoscopy costs and shortened wait times.

Identified barriers to patient navigation program implementation might be addressed by providing ongoing navigator training via multiple delivery modes; applying best practices for engaging clinic teams, gastroenterology practices, and community partners; building centralized repositories of navigation training and patient-facing materials; and securing consistent funding via billing and institutional support.