Patient navigation speeds colonoscopy after positive test
Centralized telephone navigation increased follow-up colonoscopy completion and shortened wait time after a positive fecal immunochemical test in federally qualified health centers.
*Randomized clinical trial (sub-analysis); Level 1b (OCEBM).

Citation

Ganguly AP, O’Leary MC, Crockett SD, et al. Time to Follow‑Up Colonoscopy After Positive Fecal Immunochemical Test with Centralized Patient Navigation: A Randomized Clinical Trial. Journal of General Internal Medicine. 2026;41(6):1534–1544. doi:10.1007/s11606-025-10151-2.

Background

Delays in follow-up colonoscopy after a positive stool blood test are linked to worse colorectal cancer outcomes. Under-resourced clinics often face more missed or delayed follow-up; navigation programs may help.

Patients

Adults in two federally qualified health center systems in North Carolina who completed a fecal immunochemical test and had a positive result (n=89); analysis included the first outreach round only.

Intervention

Centralized, telephone-based patient navigation to support scheduling, preparation, and practical barriers, in addition to usual care.

Control

Usual care alone (clinic notification and referral process without systematic navigation).

Outcome

Colonoscopy completion within 1 year (primary) and mean time to colonoscopy over 1 year using restricted mean survival time (days).

Follow-up Period

12 months.

Results

Outcome Intervention Control Effect
Colonoscopy completed by 1 year (primary) 69.0% (40/58) 38.7% (12/31) Absolute increase 30.3%; NNT=4
Mean time to colonoscopy over 1 year (primary) 157.0 days 237.4 days 80.4 days faster (95% confidence interval 13.6–147.1)
Analyses were intention-to-screen.

Limitations

Small positive-test sample (n=89) with wide uncertainty for timing estimates. Conducted in rural North Carolina during the COVID-19 pandemic, which may limit generalizability. Colonoscopies done outside available records could have been missed. Findings about advanced growths are hard to interpret because more patients in the intervention group completed colonoscopy.

Funding

National Institutes of Health; university cancer research funds; private gifts.

Clinical Application

For patients with a positive fecal immunochemical test in under-resourced clinics, add centralized phone navigation to increase and speed follow-up colonoscopy; evidence supports adoption.