An Evaluation of the Effectiveness of Patient Navigation on Colonoscopy Screening Adherence for Colorectal Cancer: A Randomized Controlled Trial

Despite effective screening tools, colorectal cancer (CRC) screening uptake remains low in Malaysia. We aimed to determine whether a locally contextualized patient navigation programme could improve adherence to and reduce the psychological impact of screening colonoscopy. A pilot study determined barriers to colonoscopy adherence. The navigation programme was developed (phase 1), and navigators trained (phase 2). Fifty-two average-risk patients with positive immunochemical faecal occult blood tests were randomized to the patient navigation programme (intervention) or standard care (control) (phase 3). The primary outcome was adherence to colonoscopy. Secondary outcomes, assessed pre-colonoscopy and post-colonoscopy, used the Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire-12 (GHQ-12) scores. Navigated patients were 2.4 times more likely to complete colonoscopy (P < .001), had significant reduction in anxiety (P < .001) and depression (P = .008) while general wellbeing was better (P < .001) compared with controls. This culturally contextualized navigation programme is effective in improving adherence to colonoscopy, with reduction in anxiety, depression and general psychological distress. Wider implementation should be considered in national CRC screening strategies to improve effectiveness.