Objective:

To examine factors associated with improved completion of diagnostic colonoscopy after abnormal stool-based tests, particularly in populations experiencing health disparities, as these groups have historically had disproportionately elevated colorectal cancer incidence and mortality rates.

Approach:

• Systematic Review and Meta-Analysis: The authors reviewed literature to identify evidence linking patient navigation to increased diagnostic colonoscopy completion rates.

Key Findings:

• Moderate-certainty evidence links patient navigation with clinically meaningful increases in diagnostic colonoscopy completion after positive stool tests.
• Policies requiring personal escorts for patients undergoing moderate sedation create barriers, especially for those lacking sufficient social support networks.
• No evidence demonstrates that escort policies alter procedure-related complication rates.

Interpretation:

Patients undergoing endoscopy with moderate sedation should receive individualized assessments and care plans tailored to their healthcare needs, rather than being subjected to blanket policies requiring escorts.

Limitations:

• More robust research is needed to evaluate patient safety outcomes related to discharge policies.
• Language barriers and limited health literacy can affect care delivery and transportation coordination.

Conclusion:

Removing blanket restrictions that prevent patients unable to arrange personal escorts from undergoing endoscopy will help reduce disparities in access to diagnostic colonoscopies.

Sources:

• Journal of General Internal Medicine