S261 Effect of a Patient Navigator on Colonoscopy Completion in FIT Positive Patients Refractory to Initial Scheduling Attempts

Abstract

Introduction: Decreased time from positive fecal immunochemical test (FIT) to colonoscopy is associated with decreased morbidity and mortality from colorectal cancer. However, colonoscopy is often delayed or forgone for a variety of reasons. Prior studies have shown that patient navigation for FIT+ patients increases the likelihood of colonoscopy completion. The purpose of this study was to evaluate the impact of a patient navigator on improvement in colonoscopy completion in Veterans who had not completed timely colonoscopy after FIT+. Methods: Patients in the Veterans Affairs Puget Sound Health Care System with FIT+ between 1/1/2020 and 6/30/2021 who had not yet completed colonoscopy were randomized in 11/2021 to: 1) navigation with a mailed letter and phone call from a trained, non-clinical staff member, 2) mailed letter only, or 3) control. The patient navigator provided basic education to the patient, elicited barriers to care, and facilitated seamless interaction with the primary care team. Demographic variables were recorded from the medical record. The Care Assessment Need (CAN) score was used to assess comorbid status. Outcomes were assessed as of 6/1/2022. Binary logistic regression and Kaplan Meier analyses were performed using SPSS. Results: 170 FIT+ patients were identified and 56, 56, and 58 patients were assigned to the Navigator, Mailed Letter, and Control groups, respectively. Patient demographics were similar between cohorts (Table). Colonoscopy completion was significantly increased in the Navigator group (p < 0.05), while the letter alone had no significant impact (Table). Navigation was also associated with improved documentation of reasons for no colonoscopy (p < 0.05). Adjusting for measured covariates, compared to the Navigator group, the odds of colonoscopy completion was significantly lower for the Mailed Letter group (OR 0.31 (CI 0.14-0.67)) and the Control group (OR 0.37 (CI 0.17-0.78)). Kaplan Meier analysis (Figure) revealed statistically significant differences in time to colonoscopy between the three groups. Conclusion: Patient navigation with a trained non-clinical staff member significantly improves colonoscopy completion following FIT+ in patients who are refractory to initial attempts at timely colonoscopy. Mailing a letter alone had no significant benefit. Further efforts are needed to ensure timely and complete diagnostic evaluation of patients with FIT+ screening. This study was sponsored by a grant from the American Cancer Society.Figure 1.: Kaplan Meier for Colonoscopy Completion Following FIT+ (p = 0.05) Table 1. - Demographic Information and Descriptive Results Overall (n = 170) Navigator (n = 56) Mailed Letter Only (n = 56) Control (n = 58) Mean Age (years) 67.3 65.8 68.6 67.5 Sex (% men) 90.1 89.3 91.1 91.4 Race (% white) 80.1 76.8 85.7 79.3 Hispanic Status (% Hispanic) 0.01 0.0 0.02 0.0 Mean CAN Score 60.0 62.2 57.7 60.0 Referral to GI Placed (%) 82.9 87.5 85.7 75.9 Colonoscopy Completed (%) 28.8 41.1 23.2 22.4 Colonoscopy Completed or Appropriate Reason for no Colonoscopy (%) 47.1 66.1 33.9 39.7 Median Days from FIT+ to Colonoscopy 211 230 235 196