How Patient Navigation Can Increase Screening

Overview

Patient navigators work with people, their families, and their caregivers to help them get health care. Patient navigators help people get screened for colorectal cancer by:

• Telling patients why screening is important.
• Reminding patients about upcoming appointments.
• Explaining how to complete screening tests.
• Providing resources to patients who need transportation, child or elderly care, or language translation.

CDC scientists studied two patient navigation programs. The results show that patient navigators can help people with social needs get screened for colorectal cancer at a reasonable cost.

MedStar helps patients with social needs

The District of Columbia Department of Health (DC Health) receives funds from CDC's Colorectal Cancer Control Program (CRCCP) to increase colorectal cancer screening. DC Health works with MedStar Health, a nonprofit hospital system with 10 hospitals and 300 locations in the Washington, DC area.

MedStar's Washington Hospital Center has a patient navigation program to increase the number of patients who get screened for colorectal cancer. Patients who have two or more social needs are referred to a patient navigator for help. Social needs may include a lack of transportation, speaking a language other than English, trouble understanding instructions, lack of money, and not having a person to go with them to a colonoscopy.

In 2023, 1,287 patients were referred for patient navigation. In that year:

• 94 patients were referred for a stool test, and 35 of them completed the test.
• 1,153 patients were referred for a screening colonoscopy, and 504 of them completed the colonoscopy.
• 40 patients were referred for a follow-up colonoscopy, and 21 of them completed it. A follow-up colonoscopy is done after a person has abnormal results on a stool test.
• 269 patients had an appointment scheduled to get a screening or follow-up test.
• Patient navigators were unable to contact 290 patients through phone calls or text messages.
• The overall cost per patient referred for patient navigation was $209.83. Including only patients who completed a screening or follow-up test, the cost per patient was $482.23.

This study shows that patient navigation was successful in referring patients for colorectal cancer screening.

Citation

Tangka FKL, Hoover S, Krudy M, et al. Outcomes and cost of patient navigation in increasing colorectal cancer screening in a safety net hospital-based health center. Cancer Causes Control 2026;37(3):39.

AltaMed reminds patients to return their test kit

AltaMed is a large federally qualified health center in California that receives funds from CRCCP. A federally qualified health center gets money from the federal government to provide health care to people even if they can't afford to pay for it.

In 2021, AltaMed started using patient navigation to increase colorectal cancer screening. If a patient received a stool test kit but didn't return the completed test, patient navigators sent a text message after 1 week and called the patient after 6 weeks to remind the patient to return the test. These calls and text messages were in the patient's preferred language of English or Spanish.

This study looked at AltaMed's patient navigation program from the year before it started in 2020 through 2023. The program changed in several ways over this time:

• The program made reminder phone calls more quickly. In 2021, if a patient did not return the FIT kit within 4 to 6 weeks, the patient navigator made a reminder call to the patient. In 2022 and 2023, the patient navigator made the first call after 1 to 2 weeks. In 2023, a second call was made to those who did not return the FIT kit within 6 weeks.
• The program sent a second reminder text when needed. In 2021 and 2022, if the patient did not return the FIT kit to AltaMed within 1 week, the patient navigator would text the patient a reminder to do so. In 2023, a second reminder text was sent to those who did not return the FIT kit within 6 weeks.
• At first, AltaMed used only fecal immunochemical test (FIT) kits. Starting in 2022, AltaMed began mailing FIT-DNA (Cologuard) kits to patients who chose this test during a clinic visit.
• In 2021, the program updated its practice to comply with the United States Preventive Services Task Force's recommendation to start colorectal cancer screening at age 45 instead of 50.

The study found:

• The percentage of patients who received patient navigation and returned their FIT kit increased from 37% in 2021 to 51% in 2023.
• The total cost per year of patient navigation, mass mailings, and FIT kits ranged from about $328,000 to $388,000 across the 3 years.
• The cost to AltaMed per person who received patient navigation and completed a FIT kit went down from $32 in 2021 to $25 in 2023.
• For each patient who received patient navigation and used a FIT kit, the total cost (including the cost to AltaMed and the cost of processing the test) dropped from $54 in 2021 to $47 in 2023. For each patient who received patient navigation and used a FIT-DNA (Cologuard) kit, the total cost was $512 in 2022 and $513 in 2023.

This study offers an example of how patient navigation can help patients get screened for colorectal cancer.

Citation

Tangka FKL, Ruiz E, Ibarra R, et al. Effectiveness and cost of implementing a patient navigation program to increase colorectal cancer screening in a large federally qualified health center. Cancer 2025;131(16):e70031.