The Association of a Colorectal Cancer Screening Patient Navigation Program With Adherence to Timely Surveillance Colonoscopies

Abstract

Purpose: Reduction in incidence and mortality of colorectal cancer (CRC) has been attributed to colonoscopy for detection and removal of precursor lesions/polyps. Post-polypectomy patients are often at higher risk of developing cancer and require follow-up surveillance colonoscopy (FSC). Patient navigation (PN) has been effective in improving screening in low income and minority populations; however, the literature is scarce on its effect on timely FSC. Our objectives were to compare the proportions of timely FSCs in patients who had received PN for initial colonoscopy to patients without PN and to identify reasons for non-adherence with FSC in underserved populations. Methods: In this retrospective, matched cohort study, we reviewed the charts of Massachusetts General Hospital (MGH) Chelsea health center primary care patients who received PN at their initial colonoscopy between 2010-2011 and had abnormal finding requiring surveillance. These patients were matched in a 1:3 ratio by age, gender, race, language and CRC risk category to patients with an abnormal colonoscopy during the same period who required FSC, but were not navigated. The primary outcome was proportion of timely FSC, defined as colonoscopy completed within six months of the recommended date based on the CRC risk score, in navigated vs. non-navigated group. We used a chi-square test for unadjusted comparison and multivariable logistic regression with adjustment for health insurance, education and prior number of annual visits. Our secondary outcome were reasons for non-adherence to timely completion of FSC. Results: Among 216 patients, 34 (55%) who received PN, completed a timely FSC compared to 82 (53%) in the control group (p=0.881). After adjusting for insurance, education, language and number of annual primary care visits, patients who received PN had similar odds (AOR=1.209, 95% CI 0.622-2.349) of completing a timely surveillance when compared to those who did not receive PN. The reasons for non-adherence with timely FSC were related to patients’ issues: declined, moved/traveled, co-morbidities and death. System and provider barriers included: patient referred but scheduling issues, provider miscommunication and delayed referral. Conclusions: Navigation in under served patients for initial colonoscopy did not improve odds of timely FSC. Understanding the multiple reasons for non-adherence could guide future initiatives to improve FSC rates in this population.