“If it wasn’t for you, I wouldn’t have made the appointment”: Eight Patient Navigation Techniques for Colonoscopy Barriers Resolution

OBJECTIVE: Patient navigation is an evidence-based approach for increasing colorectal cancer (CRC) screening. Research examining common navigator activities to support cancer screening emphasizes helping patients address barriers to screening. Understanding the techniques navigators employ to resolve specific barriers to CRC screening could more precisely define the mechanisms by which navigation works and inform the design and evaluation of future programs. The Colonoscopy Outreach for Rural Communities trial assessed a patient navigation program to increase colonoscopy completion. In this article, we explore how the Colonoscopy Outreach for Rural Communities study navigator was able to help patients resolve barriers to completing primary screening colonoscopy, and under what circumstances the navigator was not successful. METHODS: We used qualitative thematic analysis supported by the Framework Method to analyze navigator notes and interview transcripts to understand navigator resolution techniques. We conducted a descriptive analysis of navigation data to assess the proportion of barriers that were resolved for each participant in the program. RESULTS: We identified eight navigation techniques for primary screening colonoscopy barrier resolution: educating about colonoscopies (colonoscopy education), providing information about the health care system (system education), facilitating patient conversations with health care teams or insurance (facilitation), bridging to the health care system to coordinate care on behalf of the patient (bridge), helping the patient with accountability (accountability), providing emotional support (support), brainstorming solutions with patients (brainstorming), and helping with interpretation and translation (interpretation). These techniques were particularly successful in resolving scheduling (88%), knowledge (98%), transportation (82%), and language (83%) barriers. CONCLUSIONS: Understanding eight distinct techniques a navigator uses to support primary screening colonoscopy completion for colorectal cancer screening advances our understanding of how navigators can help patients resolve barriers to colonoscopy completion, and in what settings the techniques may be most effective. They may also offer a framework for design of navigation programs delivered both within and outside of the clinic setting. TRIAL REGISTRATION: ClinicalTrials.gov. Identifier: NCT05453630. Registered July 6, 2022.