Patient Navigation Increases Follow-Up Colonoscopy Rates After Abnormal Stool Tests
A randomized controlled trial published in Annals of Internal Medicine, conducted across 32 clinics in Washington state has demonstrated that patient navigation significantly improves follow-up colonoscopy completion rates among adults with abnormal stool test results.
The study, which enrolled 985 participants aged 50 to 75, tested the impact of a structured, six-topic telephone-based navigation program delivered by bilingual clinical staff. Participants who received patient navigation were significantly more likely to complete a colonoscopy within one year compared to those who received usual care (55.1% vs. 42.1%).
“Receipt of follow-up colonoscopy was higher in the patient navigation group than in the usual care group,” the study reported, with a risk difference of 13.0 percentage points (95% CI, 6.5 to 19.4).
The trial's primary outcome—colonoscopy completion at one year—was met, reinforcing patient navigation as a key intervention in closing care gaps following abnormal fecal test results. Secondary outcomes included time to colonoscopy and analysis of the intervention’s effectiveness across varying patient profiles, including those with a higher or lower baseline likelihood of completing follow-up colonoscopy without assistance. Notably, “the intervention effect was not moderated by patients’ probability of obtaining a colonoscopy without navigation,” suggesting broad benefit across patient subgroups.
Although conducted largely during the COVID-19 pandemic—an acknowledged limitation that introduced system-wide challenges to procedural access—the study still observed a clinically meaningful improvement, underscoring the robustness of the intervention.
“These findings support the effectiveness of patient navigation for follow-up colonoscopy completion,” the authors concluded.
For practicing gastroenterologists and primary care teams, the takeaway is clear: integrating structured navigation programs may be a critical step in improving colorectal cancer screening outcomes, particularly in underserved populations.
Reference
Coronado GD, Petrik AF, Thompson JH, et al. Patient navigation to improve colonoscopy completion after an abnormal stool test result : a randomized controlled trial. Ann Intern Med. Published online April 1, 2025. doi:10.7326/ANNALS-24-01885
