Nurses serving as care coordinators produced a slight increase in follow-up colonoscopy rates after primary screenings, asserts one small study.
- Patients receiving positive results from initial colon cancer screenings were somewhat more likely to follow-up with a colonoscopy when given access to a nurse care coordinator, found a study from the Journal of the American Board of Family Medicine. While the vast majority of patients at Group Health in the Seattle, Washington area already took further action when presented with the next steps for their treatment, researchers attributed a 10% bump in colonoscopy rates to the work of nurse navigators.
Dr. Beverly B. Green, MD, MPH, from the Group Health Research Institute, led the study conducted between 2008 and 2012 at 21 primary care health centers. One hundred and forty-seven patients who had positive fecal occult blood tests (FOBT) or flexible sigmoidoscopy were divided into two groups, one of which received traditional care. The other patients were assigned to a nurse care coordinator and provided with self-management support until they either completed a follow-up colonoscopy or asserted that they were refusing the procedure within six months.
“There is strong evidence that colorectal cancer (CRC) screening decreases CRC incidence and mortality,” Green and her research team wrote. “Despite the efficacy of screening, almost 40% of eligible adults are not screened at recommended intervals, and many have never had any type of CRC screening. Screening failures occur not only from a lack of screening but also from breakdowns in follow-up on positive tests, which obviate the benefits of screening.”
The nurse navigators had access to an electronic patient registry that tracked the types of care provided and notified them of new patients eligible for the intervention arm of the program. Before contacting the patient or physician, the navigator reviewed the patient’s EHR chart to ensure that all information about tests or other follow-up was accurate, then alerted the care giver or the patient when something was incomplete.
“The nurse assisted the patient in completing colonoscopy, including resolving barriers such as understanding insurance coverage, making an appointment, planning for preparation and transportation, and addressing concerns or ambivalence about testing,” the study explains. “The nurses used motivational interviewing techniques, and their phone conversations with participants were periodically monitored or directly observed by study personnel. After diagnostic testing was completed, the nurse also confirmed that documentation was complete, including ensuring that a copy of the colonoscopy procedure report and pathology (if a biopsy was performed) were entered into the EHR.”
The trial took place in a setting where “traditional care” already included the routine use of the electronic patient registry and automated physician follow-up, which makes it no surprise that even the control group experienced colonoscopy follow-up rates of 80 percent. Patients who accepted the help of a nurse navigator experienced compliance rates of 91 percent. The study does not consider the difference to be statistically significant, yet does attribute the increase to the navigation program.
“Larger studies are needed to confirm the independent benefits of registries, potential incremental benefits of navigation, and whether navigation increases diagnostic evaluations beyond 6 months,” the study concludes. “In addition, navigation may have differential benefits in settings without robust systems for follow-up or for populations with health disparities. Future studies of different populations should investigate these potential differences.”