Abstract PO-272: COVID-19 adaptations to patient navigation services for follow-up colonoscopy after an abnormal fecal test result in a community health center setting
Authors: Thompson Jamie , Rivelli Jennifer , Petrik Amanda , Schneider Jennifer , Yadav Neha , Dinh Hanna , Pulido Cindy , Mendez Shirley , Torres DeeDee , Penimarthi Lakshmi , Coronado Gloria 
Published: December 2020

Abstract
The PRECISE study tests the effectiveness of a targeted patient navigation program for follow-up colonoscopy after an abnormal fecal test result in a community health center setting. We present adaptations and mid-study learnings related to the COVID-19 pandemic. Colorectal cancer (CRC) screening by annual fecal immunochemical test (FIT) is an accessible and cost-effective strategy to lower CRC incidence and mortality. However, this mode of screening depends on follow-up colonoscopy after an abnormal FIT result to prevent CRC or find it in early, treatable forms. Unfortunately, almost half of patients with an abnormal FIT result fail to complete this essential screening component, negating any benefit of FIT screening. Patient navigation can provide much needed support for patients to complete a follow-up colonoscopy. 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). As part of the study, we trained a bilingual (English and Spanish) patient navigator using an intensive 8-week program, based on the New Hampshire Colorectal Cancer Screening Program. The program included multiday trainings on CRC health
information, colonoscopy steps, patient navigator skills, the navigation protocol, data reporting; a full-day motivational interviewing training delivered by a professional trainer; and in-person meetings with schedulers at local gastroenterology (GI) offices. On March 13, 2020, study enrollment for PRECISE was suspended due to the COVID-19 pandemic during which time all non-urgent medical procedures, including colonoscopies, were canceled or delayed. We trained our patient navigator to outreach to all randomized patients for whom navigation was in process at the time of study suspension. We developed COVID-19-specific talking points, and the outreach protocol was modified to address colonoscopy scheduling delays. To-date, 252 patients have been randomized (124 to navigation and 128 to usual care).
Navigator conversations with local GI offices revealed several COVID-related GI practice changes: the pre-procedure consultation is generally delivered as a telehealth (phone-based) visit and COVID-19 testing is required prior to the colonoscopy. Furthermore, many practices mandate the use of face masks by patients and their escorts, and prohibit escorts from accompanying the patient in the pre-procedure area. We adapted navigator messages to address fear and anxiety about getting medical care during the peak COVID-19 pandemic. This innovative clinical trial highlights the importance of patient navigation to improve CRC screening in community health centers and examines COVID-19 adaptions to the navigation intervention.
Citation Format: Jamie Thompson, Jennifer Rivelli, Amanda Petrik, Jennifer Schneider, Neha Yadav, Hanna Dinh, Cindy Pulido, Shirley Mendez, DeeDee Torres, Lakshmi Penimarthi, Gloria Coronado. COVID-19 adaptations to patient navigation services for follow-up colonoscopy after an abnormal fecal test result in a community health center setting [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-272.