The Need for an Integrated Patient Navigation Pathway to Improve Access to Colonoscopy After Positive Fecal Immunochemical Testing: A Safety-Net Hospital Experience
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Colorectal cancer (CRC) is a leading cause of cancer-related deaths in the United States. Delays in access to colonoscopy following positive fecal immunochemical test (FIT) contribute to increased CRC incidence and mortality. To evaluate intervals from positive FIT result to receipt of colonoscopy among underserved safety-net populations. We retrospectively evaluated all average CRC risk adults who had positive FIT results from 2012 to 2015 at an ethnically diverse safety-net hospital system. Interval from positive FIT to receipt of colonoscopy was evaluated with Kaplan Meier methods and multivariate Cox proportional hazards models. Among 467 patients with positive FIT (48.4 % men, 39.5 % black, 22.5 % white, 17.4 % Asian, 9.7 % Hispanic, mean age 59.5 ± 9.8 years), mean time from positive FIT to receipt of colonoscopy was 220.5 days (SD 158.5). Compared to men, there was a trend towards longer time from FIT positive to colonoscopy among women (237.1 vs. 198.7 days, p = 0.07). No race/ethnicity-specific disparities in time to colonoscopy were observed. Compared to 2012–2013, there was a 27.2 % reduction in time from FIT positive to colonoscopy in 2014–2015 (173.9 vs. 238.8 days, p < 0.01). Among patients undergoing colonoscopy, 46.3 % had adenomatous polyps, 27.4 % had high risk adenomatous polyps, and 5.6 % had CRC. Among an ethnically diverse safety-net hospital system, improvements in access to colonoscopy after positive FIT were observed. However, patients still waited nearly 6 months from time of positive FIT to undergoing colonoscopy. Delays in receipt of colonoscopy are complex and reflect system-level and individual patient-level barriers.
KeywordsAccess to care Colonoscopy Colon cancer Screening Safety-net
Compliance with Ethical Standards
Conflict of Interest
The authors of this manuscript have no conflicts of interest to disclose.
- 6.Meester RG, Zauber AG, Doubeni CA, et al. (2016). Consequences of increasing time to colonoscopy examination following positive result from fecal colorectal cancer screening test. Clinical Gastroenterology and Hepatology: The Official Clinical Practice Journal of the American Gastroenterological Association. doi: 10.1016/j.cgh.2016.05.017.Google Scholar
- 7.Chubak J, Garcia MP, Burnett-Hartman AN, et al. (2016). Time to colonoscopy after positive fecal blood test in four U.S. Health Care Systems. Cancer epidemiology, biomarkers & prevention: A publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 25(2), 344–350. doi: 10.1158/1055-9965.EPI-15-0470.Google Scholar
- 11.Lumpkins, C., Cupertino, P., Young, K., Daley, C., Yeh, H., & Greiner, K. (2013). Racial/ethnic variations in colorectal cancer screening self-efficacy, fatalism and risk perception in a safety-net clinic population: Implications for tailored interventions. Journal of Community Medicine & Health Education, 3.Google Scholar
- 17.Gupta S, Halm EA, Rockey DC, et al. (2013). Comparative effectiveness of fecal immunochemical test outreach, colonoscopy outreach, and usual care for boosting colorectal cancer screening among the underserved: A randomized clinical trial. JAMA Internal Medicine, 173(18), 1725–1732. doi: 10.1001/jamainternmed.2013.9294.PubMedPubMedCentralGoogle Scholar
- 18.Humphrey, L. L., Shannon, J., Partin, M. R., O’Malley, J., Chen, Z., & Helfand, M. (2011). Improving the follow-up of positive hemoccult screening tests: An electronic intervention. Journal of General Internal Medicine, 26(7), 691–697. doi: 10.1007/s11606-011-1639-3.CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Stock, D., Rabeneck, L., Baxter, N. N., et al. (2015). Mailed participant reminders are associated with improved colonoscopy uptake after a positive FOBT result in Ontario’s ColonCancerCheck program. Implementation Science: IS, 10, 35. doi: 10.1186/s13012-015-0226-0.CrossRefPubMedPubMedCentralGoogle Scholar