RT Journal Article
SR Electronic
T1 Results of Nurse Navigator Follow-up After Positive Colorectal Cancer Screening Test: A Randomized Trial
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 789
OP 795
DO 10.3122/jabfm.2014.06.140125
VO 27
IS 6
A1 Beverly B. Green
A1 Melissa L. Anderson
A1 Ching-Yun Wang
A1 Sally W. Vernon
A1 Jessica Chubak
A1 Richard T. Meenan
A1 Sharon Fuller
YR 2014
UL http://www.jabfm.org/content/27/6/789.abstract
AB 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. Impact: 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.