Abstract C106: Multilevel patient navigator-led intervention to optimize colonoscopy completion after an abnormal fecal immunochemical test
Authors: Hernandez Monica , Nodora Jesse , Bharti Balambal , Diaz Jose L , Marquez Jessica , Garcia-Bigley Felipe , Ramers Christian , Haughton Jessica , Arredondo Elva , Gupta Samir 
Published: September 2020

Purpose: Impact of colorectal cancer (CRC) screening with the fecal immunochemical test (FIT) depends on completion of diagnostic colonoscopy after abnormal FIT, as failure to complete diagnostic colonoscopy is associated with 2.4 fold increased risk of CRC death. Colonoscopy completion after abnormal FIT ranges from 18% to 57% among Federally Qualified Health Centers (FQHCs) in San Diego County. Our goal is to report the initial successes and challenges of a multi-level, patient navigator (PN) led intervention to optimize colonoscopy completion after abnormal FIT faced largely by Hispanic/Latino patients in our geographic area. Methods: At a single primary clinic within a large FQHC in San Diego’s predominantly Latino community, we implemented a multi- component intervention to promote colonoscopy completion for patients with abnormal FIT led by a bilingual/bicultural PN. PN responsibilities included monitoring timely review of FIT results by ordering provider, results provision to patients, insurance authorization, facilitating referrals for GI consultation and colonoscopy scheduling. Health system barriers (such as failure to order colonoscopy) were addressed by having the PN prompt the relevant team member to complete required care steps. Patient barriers (such as understanding FIT results, procedure scheduling and fears) were addressed through phone and in-person encounters by the PN. Summary: During the period of March to August 2017, 45 patients had an abnormal FIT. Out of 45 patients, three were not eligible for navigation due to prior colonoscopy completion. Of the remaining 42, 26 did not complete colonoscopy (14 lost to follow-up, 4 pending GI consult, 4 pending colonoscopy, 4 declined). The PN directly interacted with 28 patients of which 16 (57%) successfully completed colonoscopy. These preliminary results show a low overall rate of colonoscopy completion (16/45=36%) with nearly one third of patients (14/45=31%) lost to follow-up. Conclusions: In our initial experience with a PN-led, multi-level intervention for promoting colonoscopy completion after abnormal FIT, 57% of patients who interacted with the PN completed a colonoscopy procedure. Challenges such as loss to follow up remain a barrier to intervention success. Our results suggest that multi-level interventions led by a PN have potential to optimize follow through of colonoscopy completion after abnormal FIT.

Citation Format: Monica Hernandez, Jesse Nodora, Balambal Bharti, Jose L Diaz, Jessica Marquez, Felipe Garcia-Bigley, Christian Ramers, Jessica Haughton, Elva Arredondo, Samir Gupta. Multilevel patient navigator-led intervention to optimize colonoscopy completion after an abnormal fecal immunochemical test [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C106.