Article Impact Level: HIGH Data Quality: STRONG Summary of Annals of Internal Medicine, ANNALS-24-01885. https://doi.org/10.7326/ANNALS-24-01885 Dr. Gloria D. Coronado, et al.
Points
- This study tested whether patient navigation could improve follow-up colonoscopy rates for adults with abnormal stool tests and found significantly higher completion among those receiving structured telephone-based support.
- Participants in the navigation group completed colonoscopies at a rate of 55.1 percent versus 42.1 percent in the usual care group, showing a 13-point improvement attributable to the intervention.
- The average time to colonoscopy was reduced by 27 days in the navigation group, suggesting that patient navigation increased follow-up and expedited access to diagnostic procedures.
- The intervention was equally effective across patient subgroups and included repeated outreach efforts, indicating that personalized follow-up helped overcome barriers regardless of the initial likelihood of adherence.
- Despite limitations from the COVID-19 pandemic, the study strongly supports implementing patient navigation to boost colonoscopy rates and improve colorectal cancer prevention in underserved populations.
Summary
This study aimed to evaluate the effectiveness of patient navigation in improving colonoscopy completion rates for individuals with abnormal stool test results. A randomized controlled trial (PRECISE) was conducted at federally qualified health centers in Washington state, enrolling 985 patients aged 50-75 years. Participants were assigned either to a patient navigation group (n=479) or usual care (n=488). The intervention consisted of a 6-topic, telephone-based navigation program delivered by bilingual clinical staff. The primary outcome was the completion of a follow-up colonoscopy within one year. Secondary outcomes included time to colonoscopy and effectiveness based on patient characteristics.
Results indicated a significantly higher colonoscopy completion rate in the patient navigation group (55.1%) compared to the usual care group (42.1%), with a risk difference of 13.0 percentage points (95% CI, 6.5 to 19.4 percentage points). Additionally, the time for follow-up colonoscopy was shorter in the navigation group, with an average of 229 days compared to 256 days in the usual care group. The intervention’s effect was consistent regardless of patients’ baseline likelihood of obtaining a colonoscopy. The study also found that patient navigation improved adherence to colonoscopy procedures, as participants received a structured support system that included up to 12 follow-up attempts if necessary.
The study’s limitations include conducting the trial during the COVID-19 pandemic, which may have introduced additional barriers to care. However, the results provide strong evidence for the efficacy of patient navigation in improving colonoscopy completion rates and reducing time to follow-up. These findings support the use of patient navigators in clinical settings, especially for patients with abnormal stool test results, as a strategy to enhance colorectal cancer prevention through timely diagnosis.
Link to the article: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01885
References Coronado, G. D., Petrik, A. F., Thompson, J. H., Leo, M. C., Slaughter, M., Gautom, P., Hussain, S. A., Mosso, L., Gibbs, J., Yadav, N., Mummadi, R. R., Johnson, E. S., & Jimenez, R. (2025). Patient navigation to improve colonoscopy completion after an abnormal stool test result: A randomized controlled trial. Annals of Internal Medicine, ANNALS-24-01885. https://doi.org/10.7326/ANNALS-24-01885
