The COMPLETE-CRC Screening Initiative: Increasing Colonoscopy Completion After Positive Stool-Based Colorectal Cancer Screening.

BACKGROUND

Stool-based tests (SBTs) are increasingly used for colorectal cancer (CRC) screening; however, follow-up colonoscopy rates after positive results remain suboptimal.

AIMS: To reach colonoscopy completion rates of ≥ 80% within 6 months of patient navigator contact among all Ohio patients with positive SBTs in the year prior to contact and to identify factors associated with completion.

METHODS

This quality improvement study included adults aged 45-75 years with positive SBT between August 1, 2023, and August 1, 2024, at Cleveland Clinic. Patients who had not completed a colonoscopy within 360 days of a positive SBT were contacted by a patient navigator via phone and/or the patient portal (MyChart) to address the importance of colonoscopy, scheduling, and documented barriers. Patients were classified as direct contact if they answered a telephone call or a MyChart message, and as indirect outreach if neither occurred. The primary outcome was colonoscopy completion 6 months after navigator contact. Multivariable logistic regression was used to assess factors associated with completion.

RESULTS

Of 2,548 patients with positive SBT, 803 (31.5%) had not completed colonoscopy within 360 days. Among 476 Ohio patients, 144 (30.3%) had direct contact and 332 (69.7%) had indirect outreach; 31 underwent colonoscopy, and 26 were scheduled for colonoscopy, increasing overall colonoscopy completion rates from 68.5% to 70.2%. Among 47 patients, reported barriers included limited knowledge (31.9%), transportation challenges (31.9%), prior negative experiences (10.6%), fear (8.5%), cost concerns (4.3%), and communication gaps (6.4%). Direct patient contact was associated with significantly higher colonoscopy completion than indirect outreach (16.7% vs 2.1%; p < 0.001). In univariable analysis, increasing age was associated with lower odds of completion after outreach (OR 0.94; 95% CI 0.90-0.98; p = 0.004) and remained significant after adjusting for race and insurance (aOR 0.94; 95% CI 0.90-0.98; p = 0.007).

CONCLUSIONS

Patient outreach was associated with increased colonoscopy completion after a positive SBT, whereas older age was associated with lower completion rates. Despite improvements, completion remained suboptimal, underscoring the need to optimize CRC screening outreach.

CLINICAL TRIAL NUMBER: not applicable.