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

Vivy T Cusumano^{1

2}, Anthony Myint^{1

2}, Edgar Corona^{1

2}, Liu Yang^{1

2}, Jennifer Bocek^{1

3}, Antonio G Lopez¹, Marcela Zhou Huang¹, Naveen Raja^{1

3}, Anna Dermenchyan^{1

4}, Lily Roh^{1

3}, Maria Han^{1

4}, Daniel Croymans^{1

4}, Folasade P May^{5

6

7

8}

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.
² Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
³ Faculty Practice Group and Office of Population Health and Accountable Care, University of California Los Angeles, Los Angeles, CA, USA.
⁴ Quality Program, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
⁵ 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. fmay@mednet.ucla.edu.
⁶ Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. fmay@mednet.ucla.edu.
⁷ Cancer Prevention Control Research, UCLA Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA. fmay@mednet.ucla.edu.
⁸ Department of Medicine, Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. fmay@mednet.ucla.edu.

PMID: 33609211
DOI: 10.1007/s10620-021-06866-x

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

Vivy T Cusumano et al. Dig Dis Sci. 2021 Nov.

. 2021 Nov;66(11):3760-3768.

doi: 10.1007/s10620-021-06866-x. Epub 2021 Feb 20.

Authors

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.
² Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
³ Faculty Practice Group and Office of Population Health and Accountable Care, University of California Los Angeles, Los Angeles, CA, USA.
⁴ Quality Program, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
⁵ 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. fmay@mednet.ucla.edu.
⁶ Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. fmay@mednet.ucla.edu.
⁷ Cancer Prevention Control Research, UCLA Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA. fmay@mednet.ucla.edu.
⁸ Department of Medicine, Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. fmay@mednet.ucla.edu.

PMID: 33609211
DOI: 10.1007/s10620-021-06866-x

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.

Keywords: Cancer screening; Colorectal cancer; Prevention; Stool-based test.

PubMed Disclaimer

Comment in

Paying Attention to Miss(ed) FITs.
White PM, Itzkowitz SH. White PM, et al. Dig Dis Sci. 2021 Nov;66(11):3659-3660. doi: 10.1007/s10620-021-06871-0. Epub 2021 Feb 20. Dig Dis Sci. 2021. PMID: 33609210 Free PMC article. No abstract available.

References

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1. Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: recommendations for physicians and patients from the us multi-society task force on colorectal cancer. Am J Gastroenterol. 2017;112:1016–1030. https://doi.org/10.1038/ajg.2017.174 . - DOI - PubMed
1. Robertson DJ, Lee JK, Boland CR, et al. Recommendations on fecal immunochemical testing to screen for colorectal neoplasia: a consensus statement by the US multi-society task force on colorectal cancer. Gastroenterology. 2017;152:1217-37.e3. https://doi.org/10.1053/j.gastro.2016.08.053 . - DOI
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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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Patient Navigation After Positive Fecal Immunochemical Test Results Increases Diagnostic Colonoscopy and Highlights Multilevel Barriers to Follow-Up

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Medical