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- Title
Patient Navigation After Positive Fecal Immunochemical Test Results Increases Diagnostic Colonoscopy and Highlights Multilevel Barriers to Follow-Up.
- Authors
Cusumano, Vivy T.; Myint, Anthony; Corona, Edgar; Yang, Liu; Bocek, Jennifer; Lopez, Antonio G.; Huang, Marcela Zhou; Raja, Naveen; Dermenchyan, Anna; Roh, Lily; Han, Maria; Croymans, Daniel; May, Folasade P.
- Abstract
Background: The fecal immunochemical test (FIT) is a common colorectal cancer screening modality in the USA but often is not followed by diagnostic colonoscopy. Aims: We investigated the efficacy of patient navigation to increase diagnostic colonoscopy after positive FIT results and determined persistent barriers to follow-up despite navigation in a large, academic healthcare system. Methods: The study cohort included all health system outpatients with an assigned primary care provider, a positive FIT result between 12/01/2016 and 06/01/2019, and no documentation of colonoscopy after positive FIT. Two non-clinical patient navigators engaged patients and providers to encourage follow-up, offer solutions to barriers, and assist with colonoscopy scheduling. The primary intervention endpoint was completion of colonoscopy within 6 months of navigation. We documented reasons for persistent barriers to colonoscopy despite navigation and determined predictors of successful follow-up after navigation. Results: There were 119 patients who received intervention. Of these, 37 (31.1%) patients completed colonoscopy at 6 months. In 41/119 (34.5%) cases, the PCP did not recommend colonoscopy, most commonly due to a normal colonoscopy prior to the positive FIT (19, 46.3%). There were 41/119 patients (34.5%) that declined colonoscopy despite the patient navigator and the PCP order. Male sex and younger age were significant predictors of follow-up (aOR = 2.91, 95%CI, 1.18-7.13; aOR = 0.92, 95%CI, 0.87-0.99). Conclusions: After implementation of patient navigation, diagnostic colonoscopy was completed for 31.1% of patients with a positive FIT result. However, navigation also highlighted persistent multilevel barriers to follow-up. Future work will develop targeted solutions for these barriers to further increase FIT follow-up rates in our health system.
- Subjects
COLONOSCOPY; COLORECTAL cancer; PNEUMOCYSTIS pneumonia; PRIMARY care; EARLY detection of cancer; DOCUMENTATION
- Publication
Digestive Diseases & Sciences, 2021, Vol 66, Issue 11, p3760
- ISSN
0163-2116
- Publication type
Article
- DOI
10.1007/s10620-021-06866-x