About two-thirds of minority patients referred for colonoscopy by a primary care physician completed the procedure if they were guided along the way by a patient navigator, according to the findings of an observational study.
The use of a patient navigator also enhanced compliance with the bowel preparation process and increased patient satisfaction with the procedure, reported Dr. Lee Ann Chen of the Mount Sinai School of Medicine, New York, and her coinvestigators.
Patient navigation is part of the facility's ongoing efforts to increase screening colonoscopy by decreasing organizational barriers, the authors said. This effort began with an open-access referral program, in which primary care physicians were able to refer patients directly for the procedure, bypassing evaluation by a gastroenterologist.
“This decreases the number of appointments a patient must complete before obtaining a screening colonoscopy and shortens the time to screening colonoscopy … open access can increase the number of screening colonoscopies and enhance neoplasm detection,” they wrote.
To further increase screening rates, they added a bilingual (Spanish/English) female health educator as a patient navigator. She received specialized training on colonoscopy and guided each referred patient through the process. This involved gathering medical information, scheduling the colonoscopy, explaining the bowel prep process, frequently reminding patients of their appointment by phone and mail, and even personally meeting with patients who were fearful of the procedure.
The authors presented results from 532 patients who had used the services of a patient navigator. Their mean age was 56 years; 79% were female. Hispanic patients made up 55% of the group; 31% were black; the rest were other ethnic groups.
Overall, 353 (66%) completed their colonoscopy. Reasons for noncompletion among the remaining 179 patients were the desire to speak in detail with their physician before the procedure (14) and refusal to undergo the procedure (52). Forty-seven patients never returned the navigator's phone calls, 14 rescheduled their colonoscopies more than four times, and 52 did not show up for their scheduled colonoscopies twice.
Women were 31% more likely to complete the colonoscopy than men. Of the completers, 60% were Hispanic and 28% were black. Hispanic patients were 67% more likely than were blacks to complete the colonoscopy, while Hispanic women were 50% more likely to complete the colonoscopy than Hispanic men were. There were no significant gender differences among black patients.
Bowel prep information was available for 330 patients who completed the procedure. Of these, 9% of the bowel preparations were rated as excellent, 34% were very good, 48% were good, 4% were fair, and 5% were poor. The facility's historical percentage of poor preps was 12%.
Overall, 34% of patients had a polyp or mass removed and biopsied. Among the 58 patients with an adenoma, 12% had villous histology, 12% had an adenoma larger than 1 cm, and 5% had an adenoma with high-grade dysplasia or cancer. Two patients had an advanced adenoma. Both patients underwent surgical resection with no residual cancer at the polypectomy site or in the regional lymph nodes.
A subset of patients (196) completed a patient satisfaction survey. Most (84%) said their primary care physician adequately explained the reason for their screening colonoscopy, but that figure rose to 92% after contact with the patient navigator. Likewise, 86% said they were extremely satisfied with their primary care physician's explanation of the bowel prep, but that number rose to 99% after contact with the navigator. A high percentage (87%) said the navigator was able to calm their preprocedure fears, and 66% said they would not have completed the colonoscopy without the navigator's attention.