Abstract PO-246: Supporting community health center patients in completing follow-up colonoscopy: A qualitative summary of patient navigation activities
Authors: Schneider Jennifer L. , Rivelli Jennifer S. , Thompson Jamie , Petrik Amanda , Yadav Neha , Dinh Hanna , Pulido Cindy , Mendez Shirley , Torres DeeDee , Coronado Gloria 
Published: December 2020

Background Fecal immunochemical tests (FITs) are an acceptable and cost-effective way to identify patients at risk for colorectal cancer (CRC). However, patients who receive an abnormal FIT result must obtain a follow-up colonoscopy. Rates of follow- up colonoscopy are low in most healthcare settings, particularly in federally qualified health centers (FQHCs). Half of patients with an abnormal FIT result fail to complete this essential colonoscopy screening component. Patient navigation can provide much needed support for patients to complete the follow-up colonoscopy. Methods PRECISE is a patient-randomized trial of patient navigation vs usual care for follow-up colonoscopy that will enroll 1,200 patients across 28 community health center clinics in Washington State (anticipated 37% Latinx). For the study, we trained a bilingual (native Spanish speaker) patient navigator (PN) using an intensive 8-week program, based on the New Hampshire Colorectal Cancer Screening Program. As part of the recruitment and data tracking tool used by the PN, open text fields are available for documenting interactions with navigated patients. We present a qualitative content analysis of the open text fields of navigated patients. These findings identify a broad range of supportive interactions engaged in by the PN to assist patients in overcoming barriers to follow-up colonoscopy completion. Results To-date, 124 patients have been randomized to navigation, and 44 of these had open text field documentation. Our content analysis found slightly more than half (N=23) required more intensive navigation assistance for overcoming a variety of barriers such as fear of or misinformation about the colonoscopy; help with scheduling, transportation, and interpreter services; and assistance with obtaining and completing the bowel preparation. Those that needed less navigation (N=21) mostly required assistance with scheduling the colonoscopy and often had protective factors such as prior colonoscopy experience or support from family/friends for completing the procedure. Overall, the top three areas the PN tended to provide support for overcoming barriers included: contacting the gastroenterologist office to problem- solve issues like lack of referral, scheduling delays, or to obtain appointment information (40 instances); assisting the patient with obtaining, understanding, and completing the bowel preparation including diet restrictions, medication interaction, and preparing/consuming the mixture (25 instances); and verifying, coordinating, and offering transportation/escort support before and after the colonoscopy procedure (22 instances). Conclusion The PRECISE trial highlights the importance of targeted patient navigation to improve CRC screening completion. Our open text field findings demonstrate the necessary role of patient navigation for overcoming the multitude of educational and structural challenges facing FQHC patients when attempting to complete a follow-up colonoscopy.

Citation Format: Jennifer L. Schneider, Jennifer S. Rivelli, Jamie Thompson, Amanda Petrik, Neha Yadav, Hanna Dinh, Cindy Pulido, Shirley Mendez, DeeDee Torres, Gloria Coronado. Supporting community health center patients in completing follow-up colonoscopy: A qualitative summary of patient navigation activities [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-246.