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Choice in screening test, patient navigation increases adherence to CRC screening
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Patients who were offered a choice between fecal occult blood test or colonoscopy for colorectal cancer screening had higher adherence over 3 years compared with those who were not offered a choice, according to follow-up results from a randomized trial.
“Allowing people to choose their screening test and using patient navigators to help them get their tests completed will increase the overall adherence to colorectal cancer screening,” Peter S. Liang, MD, MPH, from the division of gastroenterology at University of Washington, Seattle, told Healio Gastroenterology.
Peter S. Liang
Liang and colleagues performed a cluster randomized trial of 997 participants with average CRC risk who were assigned to be screened by fecal occult blood test (FOBT), colonoscopy, or a choice between the two. Adherence to the assigned strategy over 3 years served as the primary endpoint. Research assistants who received basic training in patient navigation assisted participants with completing their screening tests in the first year of the study period.
Previously published first-year results showed higher adherence among those assigned to be screened by FOBT or a choice between FOBT and colonoscopy. Follow-up results showed that individuals in the FOBT group were significantly less adherent over 3 years compared with those in the colonoscopy or choice groups (14% vs. 38% and 42%, respectively; both P < .001).
Multivariate analysis showed independent predictors of adherence included being assigned to the choice group, speaking Chinese, homosexuality, being married or partnered, and having a non-nurse practitioner primary care provider (all P < .01).
Furthermore, adherence across all groups declined significantly from the first year of the study period following discontinuation of patient navigation.
“Adherence decreased sharply for participants randomized to the FOBT strategy after the withdrawal of patient navigation,” the researchers wrote. “Patient navigation appears to be especially effective for racial/ethnic and linguistic minorities and may be an important intervention to achieve and sustain a high level of CRC screening.”
“For patients who are trying to decide which screening test to use, the most important thing is that you pick a test and get screened, because none of these tests can prevent colorectal cancer if you don’t go through with it,” Liang said. “The best test is the one that gets done!” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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