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Navigators Could Improve Follow-Up Rates After Positive Fecal Blood Tests
Patients who received a positive fecal occult blood test as an initial screening for colorectal cancer may need more counseling to ensure they go on to a follow-up colonoscopy, according to research published in The American Journal of Gastroenterology.
Diego Llovet, PhD, of Cancer Care, in Canada, and the Institute of Health Policy, Management and Evaluation at the University of Toronto, and colleagues wrote that providing the proper education and guidance could make a big difference in managing the problem of CRC.
“Delays in obtaining follow-up colonoscopy increase the risk of CRC, including advanced-stage disease while non-adherence considerably increases the risk of CRC death,” they wrote. “Timely receipt of follow-up colonoscopy is therefore critical to reducing the burden of CRC at the population level.”
Investigators conducted semi-structured interviews with 30 patients with 6- to 12-month-old positive fecal occult blood test (FOBT) but no follow-up colonoscopy, as well as 30 primary care providers with at least one patient who had an unfollowed positive FOBT. They sought to understand that reasons for the lack of follow-up and what plans were taken to address the positive test.
The most common reason for the lack of follow-up was that the patient or provider believed the test was a false positive (28/60; 11 PCPS and 17 patients). They usually attributed the test to benign bleeding, diet or medication. Some of the providers and patients felt that the risk for CRC was low because of a recent normal colonoscopy.
“Psychological theory suggests this belief may represent defensive denial, a coping mechanism whereby individuals who become anxious after receiving threatening information can temporarily reduce their anxiety by denying that the threat exists,” the researchers wrote.
Reasons for lack of follow-up also included fear about the colonoscopy, breakdown in communication on positive FOBT tests or colonoscopy appointments, and competing health issues.
As a follow-up action plan, most patients would repeat the FOBT test, while others either intentionally or unintentionally did not follow-up at all. A few of the patients reported that they made plans to undergo colonoscopy, but the screenings had not materialized due to appointment issues, delay or fear about the procedure.
Llovet and colleagues wrote that some of these problems could be mitigated by using trained navigators to guide patients through the process and arrange follow-ups.
“Trained navigators may be ideally suited to address the barriers we identified in our study, namely fear of colonoscopy, belief that the [positive FOBT] is a false positive, and breakdown in communication of [positive FOBTs] and of colonoscopy appointments,” they wrote. “Using centralized navigation to support, instead of replace, PCPs in arranging follow-up may also be considered. PCP endorsement would, however, be essential to the success of any navigation intervention.” – by Alex Young
Disclosures: Llovet reports that he is a behavioral scientist in the cancer screening unit at Cancer Care Ontario. Please see the full study for all other authors’ relevant financial disclosures.