Navigation activities in an organized colorectal cancer screening program improve follow-up colonoscopy completion

Abstract Patient navigation is a promising intervention that could improve follow-up of abnormal fecal immunochemical test (FIT) results in colorectal cancer (CRC) screening. We describe changes in navigation activities in an organized screening program aimed to improve follow-up colonoscopy completion. Between 2022 and 2023, we decreased the time between an abnormal FIT result and contact from the program’s patient navigator from 3 months to 1 month and provided the patient navigator with direct access to schedule colonoscopies at two endoscopy sites. We conducted a pre-post analysis that examined the proportion of patients with abnormal FIT results who completed a colonoscopy, were referred for a colonoscopy, time to referral, time to colonoscopy, and colonoscopy outcomes including CRC diagnoses. Our analysis included 368 patients with abnormal FIT results: 175 in 2022 and 193 in 2023. After changes to navigation activities, colonoscopy completion within 1 year increased by 22.9% points (42.9% to 65.8%; p < 0.001). In 2022, the median time (interquartile range; IQR) to colonoscopy was 103.5 (IQR 60.2-161.5) days. In 2023, the median time to colonoscopy was 99.0 (IQR 52.0-150.0) days. Differences in the proportion of patients referred to colonoscopy, time to referral, and time to colonoscopy were not statistically significant. Patient navigation beginning within 1 month of an abnormal FIT result and granting a patient navigator direct access to the endoscopy scheduling template increased 1-year colonoscopy completion. Understanding navigation activities in CRC screening programs could inform broader adoption of practices that are associated with increased follow-up colonoscopy completion.