Characteristics and Effectiveness of Patient Navigation Programs on Colorectal Cancer Screening and Follow-up Colonoscopy Uptake: A Systematic Review

<h2>ABSTRACT</h2><h3>Introduction</h3> Patient navigation is an evidence-based intervention that can be used to address patient-level barriers and ultimately increase colorectal cancer (CRC) screening rates. Because implementation can affect the effectiveness of navigation programs, it is important to study the implementation and effectiveness of the programs to inform future work. <h3>Methods</h3> We conducted a systematic review of English-language academic journal articles published from 2004 through 2023 and covering studies conducted in the United States. Following literature searches in four databases, reviewers independently screened titles and abstracts for potential relevance, followed by a full-text review of articles. We abstracted data from included articles, including study characteristics, cancer screening and intervention characteristics and outcomes (when provided), and screening outcomes. We assessed the quality of included studies using the Cochrane Risk of Bias Tool for Randomized Trials (ROB 2). Our approach adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) recommendations. <h3>Results</h3> We included 30 studies, and nearly all (n=29) reported implementing multicomponent interventions, such as patient reminders, small media, mailed stool blood tests, and addressing structural barriers along alongside navigation. Existing staff or healthcare providers, research team members, and lay people served as patient navigators. After implementing patient navigation as part of the intervention, most studies reported improvement in screening uptake, averaging 16.9 percentage points. Little information was provided on implementation outcomes. <h3>Discussion</h3> Patient navigation can be an effective strategy for improving CRC screening uptake. Further research is needed to understand implementation outcomes to bolster screening impact, inform resource allocation, promote equitable implementation, and improve patient outcomes.