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Patient Navigation After Positive Fecal Immunochemical Test Results Increases Diagnostic Colonoscopy and Highlights Multilevel Barriers to Follow-Up

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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.

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Funding

This study was funded by the UCLA Melvin and Bren Simon Gastroenterology Quality Improvement Program.

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Authors and Affiliations

  1. Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA

    Vivy T. Cusumano, Anthony Myint, Edgar Corona, Liu Yang, Jennifer Bocek, Antonio G. Lopez, Marcela Zhou Huang, Naveen Raja, Anna Dermenchyan, Lily Roh, Maria Han, Daniel Croymans & Folasade P. May

  2. Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Vivy T. Cusumano, Anthony Myint, Edgar Corona, Liu Yang & Folasade P. May

  3. Faculty Practice Group and Office of Population Health and Accountable Care, University of California Los Angeles, Los Angeles, CA, USA

    Jennifer Bocek, Naveen Raja & Lily Roh

  4. Quality Program, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA

    Anna Dermenchyan, Maria Han & Daniel Croymans

  5. Cancer Prevention Control Research, UCLA Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA

    Folasade P. May

  6. Department of Medicine, Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA

    Folasade P. May

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  1. Vivy T. Cusumano
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  2. Anthony Myint
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  3. Edgar Corona
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  4. Liu Yang
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  5. Jennifer Bocek
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  9. Anna Dermenchyan
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  10. Lily Roh
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  11. Maria Han
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  13. Folasade P. May
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Correspondence to Folasade P. May.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Cusumano, V.T., Myint, A., Corona, E. et al. Patient Navigation After Positive Fecal Immunochemical Test Results Increases Diagnostic Colonoscopy and Highlights Multilevel Barriers to Follow-Up. Dig Dis Sci 66, 3760–3768 (2021). https://doi.org/10.1007/s10620-021-06866-x

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