ASPO Abstracts
Multi-level Patient Navigator Led Intervention to Optimize Colonoscopy Completion After an Abnormal Fecal Immunochemical Test
Category: Early Detection & Risk Prediction, Cancer Health Disparities
Conference Year: 2018
Abstract Body:
Purpose: Impact of colorectal cancer (CRC) screening with the fecal immunochemical test (FIT) depends on completion of diagnostic colonoscopy after abnormal FIT, as failure to complete diagnostic colonoscopy is associated with 2.5 fold increased risk of CRC death. Colonoscopy completion after abnormal FIT ranges from 43% to 50% among Federally Qualified Health Centers (FQHCs) in our geographic area. Our goal is to report the initial successes and challenges of a multi-level, patient navigator (PN) lead intervention to optimize colonoscopy completion after abnormal FIT. Methods: At a single primary clinic within a large FQHC serving San Diego county, we implemented a multi- component intervention to promote colonoscopy completion for patients with abnormal FIT lead by a bilingual/bicultural PN. PN responsibilities included monitoring timely review of FIT results by ordering provider, results provision to patients, insurance authorization, referral for GI consultation, and colonoscopy scheduling. Health system barriers (such as failure to order colonoscopy) were addressed by having the PN remind the relevant team member to complete required care steps. Patient barriers (such as understanding FIT result and follow up, and fears) were addressed through phone and in-person encounters by the PN. Results: During the period of March to August 2017, 45 patients had an abnormal FIT. Out of 45 patients, three were not eligible for navigation due to prior colonoscopy completion. Of the remaining 42, 26 did not complete colonoscopy (14 lost to follow-up, 4 pending GI consult, 4 pending colonoscopy, 4 declined). The PN directly interacted with 28 patients of which 16 (57%) successfully completed colonoscopy. These preliminary results show a low overall rate of colonoscopy completion ((16/45=36%) with nearly one third of patients (14/45=31%) lost to follow-up. Conclusions: In our initial experience with a PN-led, multi-level intervention for promoting colonoscopy completion after abnormal FIT, 57% of patients who interacted with the PN completed colonoscopy. Challenges such as loss to follow up remain a barrier to intervention success. Our results suggest that multi-level interventions lead by a PN have potential to optimize follow up after abnormal FIT.
Keywords: Patient Navigator Colorectal Cancer Interventions