Abstract B77: Knowledge of screening colonoscopy results and follow up recommendations among navigated patients
Authors: Fritz Cassandra D.L , Naylor Keith , Kim Karen 
Published: October 2015

Purpose: Patient navigation (PN) programs have increased colorectal screening (CRS) rates in uninsured patient populations. The University of Chicago (UC) partnered with the American Cancer Society (ACS) to develop a CRS initiative at the UC to improve CRS outcomes. Unlike many PN programs, the UC ACS program solely utilized community-placed navigators. Along with addressing barriers, navigators provided one-to-one patient education, pre-procedure instructions, scheduling, appointment and bowel prep reminders. Prior to their screening exam, none of the UC navigated patients had ever received care within the UC network.

The efficacy of CRS programs depends on patient awareness of results and follow-up recommendations. Currently, the only data on awareness of colonoscopy surveillance recommendations is limited to a predominantly Caucasian insured population with known adenomas. Yet it is unclear what a predominately African- American navigated patient population knows about their colonoscopy results and follow-up recommendations. Therefore, our objectives were to determine UC navigated patients' knowledge of colonoscopy results and follow-up recommendations compared to non-navigated patients.

Methods: Between Jan. to June 2014, 194 patients obtained a screening colonoscopy with one of the physicians, who were also providers for the UC ACS program. Most, 143 patients met inclusion criteria (navigated patients: initial screening colonoscopy, asymptomatic, uninsured, and age &gt; 45 / non-navigated patients: screening colonoscopy, asymptomatic, insured, and age &gt;45). A brief semi-structured telephone survey was utilized to assess patient's beliefs about CRS, knowledge of their results, and follow-up recommendations. All patients were surveyed between 4-25 weeks post colonoscopy. Statistical analysis included chi-square and logistical regression (p &lt;0.05).

Results: Of the 143 patients meeting inclusion criteria, 97 patients were reached by phone (68%). Only 1 patient refused to complete the survey providing a 98% response rate. Of the 25 ACS patients meeting inclusion criteria, 18 patients completed the survey compared to 78/119 non-navigated patients. Around 90% of the navigated patient population identified as African American (AA), compared to 64% of the non-navigated patients.

There were no statistically significance differences between navigated and non-navigated patients for sex, ethnicity, race, and education level. Non-navigated patients were more likely to report a higher income and having a primary care physician (p&lt;0.05).

Approximately 40% of navigated patients said “no” or “unsure” when asked if colon cancer could be prevented compared to 35% of non-navigated patients (p = 0.37).

100% of the navigated patients correctly reported their colonoscopy findings compared to 79.5% of the non-navigated patients (p=0.04). ACS navigation was the only significant variable found on logistical regression. In contrast, only 44.4% of the navigated patients reported the correct follow-up recommendations compared to 70.5% of non-navigated patients (p=0.04). Logistical regression analysis showed that level of patient education (OR=.32; p=0.02) and having an adenoma (OR=4.1; p=0.02) correlated with knowledge of follow-up recommendations.

Conclusions: Despite education and access to care, our study highlights the need for continued education around CRS, since less that 40% of both navigated and non-navigated patients reported screening as a colon cancer preventative procedure. Although navigated patients were more aware of their colonoscopy results than non-navigated patients, this patient population was less aware of their follow-up recommendations. Future studies need to focus on minority populations in order to ensure equal benefit from CRS and to reduce disparities from this often-preventable cancer.

Citation Format: Cassandra D.L Fritz, Keith Naylor, Karen Kim. Knowledge of screening colonoscopy results and follow up recommendations among navigated patients. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B77.