Results of nurse navigator follow-up after positive colorectal cancer screening test: a randomized trial.
BACKGROUND
Follow-up after a positive colorectal cancer screening test is necessary for screening to be effective. We hypothesized that nurse navigation would increase the completion of colonoscopy after a positive screening test.


METHODS
This study was conducted between 2008 and 2012 at 21 primary care medical centers in western Washington State. Participants in the Systems of Support to Increase Colorectal Cancer Screening study who had a positive fecal occult blood test (FOBT) or flexible sigmoidoscopy needing follow-up were randomized to usual care (UC) or a nurse navigator (navigation). UC included an electronic health record-based positive FOBT registry and physician reminder system. Navigation included UC plus care coordination and patient self-management support from a registered nurse who tracked and assisted patients until they completed or refused colonoscopy. The primary outcome was completion of colonoscopy within 6 months. After 6 months, both groups received navigation.


RESULTS
We randomized 147 participants with a positive FOBT or sigmoidoscopy. Completion of colonoscopy was higher in the intervention group at 6 months, but differences were not statistically significant (91.0% in navigation group vs 80.8% in UC group; adjusted difference, 10.1%; P = .10). Reasons for no or late colonoscopies included refusal, failure to schedule or missed appointments, concerns about risks or costs, and competing health concerns.


CONCLUSIONS
Navigation did not lead to a statistically significant incremental benefit at 6 months.


CONCLUSIONS
Follow-up rates after a positive colorectal cancer (CRC) screening test are high in a health care system where UC included a registry and physician reminders. Because of high follow-up rates in a health care system where UC included a registry and physician reminders, and small sample size, we cannot rule out incremental benefits of nurse navigation.
From the Group Health Cooperative and Group Health Research Institute, Seattle, WA (BBG, MLA, JC, SF); the Department of Epidemiology, University of Washington School of Public Health, Seattle (JC); the Fred Hutchinson Cancer Center, Seattle, WA (C-YW); the Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston (SWV); and the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RTM). green.b@ghc.org.
Beverly B
BB
Green
From the Group Health Cooperative and Group Health Research Institute, Seattle, WA (BBG, MLA, JC, SF); the Department of Epidemiology, University of Washington School of Public Health, Seattle (JC); the Fred Hutchinson Cancer Center, Seattle, WA (C-YW); the Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston (SWV); and the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RTM).
Melissa L
ML
Anderson
From the Group Health Cooperative and Group Health Research Institute, Seattle, WA (BBG, MLA, JC, SF); the Department of Epidemiology, University of Washington School of Public Health, Seattle (JC); the Fred Hutchinson Cancer Center, Seattle, WA (C-YW); the Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston (SWV); and the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RTM).
Ching-Yun
CY
Wang
From the Group Health Cooperative and Group Health Research Institute, Seattle, WA (BBG, MLA, JC, SF); the Department of Epidemiology, University of Washington School of Public Health, Seattle (JC); the Fred Hutchinson Cancer Center, Seattle, WA (C-YW); the Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston (SWV); and the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RTM).
Sally W
SW
Vernon
From the Group Health Cooperative and Group Health Research Institute, Seattle, WA (BBG, MLA, JC, SF); the Department of Epidemiology, University of Washington School of Public Health, Seattle (JC); the Fred Hutchinson Cancer Center, Seattle, WA (C-YW); the Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston (SWV); and the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RTM).
Jessica
J
Chubak
From the Group Health Cooperative and Group Health Research Institute, Seattle, WA (BBG, MLA, JC, SF); the Department of Epidemiology, University of Washington School of Public Health, Seattle (JC); the Fred Hutchinson Cancer Center, Seattle, WA (C-YW); the Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston (SWV); and the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RTM).
Richard T
RT
Meenan
From the Group Health Cooperative and Group Health Research Institute, Seattle, WA (BBG, MLA, JC, SF); the Department of Epidemiology, University of Washington School of Public Health, Seattle (JC); the Fred Hutchinson Cancer Center, Seattle, WA (C-YW); the Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston (SWV); and the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RTM).
Sharon
S
Fuller
D000368:Aged; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D062526:Patient Navigation
Cancer Screening; Colonoscopy; Colorectal Cancer; Patient Navigators