The COMPLETE-CRC Screening Initiative: Increasing Colonoscopy Completion After Positive Stool-Based Colorectal Cancer Screening

BACKGROUND: Stool-based tests (SBTs) are increasingly used for colorectal cancer (CRC) screening; however, follow-up colonoscopy rates after positive results remain suboptimal. AIMS: To reach colonoscopy completion rates of ≥ 80% within 6 months of patient navigator contact among all Ohio patients with positive SBTs in the year prior to contact and to identify factors associated with completion. METHODS: This quality improvement study included adults aged 45-75 years with positive SBT between August 1, 2023, and August 1, 2024, at Cleveland Clinic. Patients who had not completed a colonoscopy within 360 days of a positive SBT were contacted by a patient navigator via phone and/or the patient portal (MyChart) to address the importance of colonoscopy, scheduling, and documented barriers. Patients were classified as direct contact if they answered a telephone call or a MyChart message, and as indirect outreach if neither occurred. The primary outcome was colonoscopy completion 6 months after navigator contact. Multivariable logistic regression was used to assess factors associated with completion. RESULTS: Of 2,548 patients with positive SBT, 803 (31.5%) had not completed colonoscopy within 360 days. Among 476 Ohio patients, 144 (30.3%) had direct contact and 332 (69.7%) had indirect outreach; 31 underwent colonoscopy, and 26 were scheduled for colonoscopy, increasing overall colonoscopy completion rates from 68.5% to 70.2%. Among 47 patients, reported barriers included limited knowledge (31.9%), transportation challenges (31.9%), prior negative experiences (10.6%), fear (8.5%), cost concerns (4.3%), and communication gaps (6.4%). Direct patient contact was associated with significantly higher colonoscopy completion than indirect outreach (16.7% vs 2.1%; p < 0.001). In univariable analysis, increasing age was associated with lower odds of completion after outreach (OR 0.94; 95% CI 0.90-0.98; p = 0.004) and remained significant after adjusting for race and insurance (aOR 0.94; 95% CI 0.90-0.98; p = 0.007). CONCLUSIONS: Patient outreach was associated with increased colonoscopy completion after a positive SBT, whereas older age was associated with lower completion rates. Despite improvements, completion remained suboptimal, underscoring the need to optimize CRC screening outreach. CLINICAL TRIAL NUMBER: not applicable.