PROJECT SUMMARY/ABSTRACT Colorectal cancer (CRC) is the third leading cause of cancer death in the United States. Appropriate screening can reduce CRC mortality. Colonoscopy, a procedure to detect CRC early, is recommended for patients with a positive fecal immunochemical test (FIT) result to detect CRC and can even prevent CRC through the removal of pre-cancerous polyps. Rural and low-income populations face significant barriers to colonoscopy completion after positive FIT, including difficult access to the procedure (lack of local providers/long travel times), socioeconomic barriers to completing the procedure (difficulty getting time off work, arranging childcare and transportation, high out of pocket procedure costs), lack of knowledge about the procedure and its role in CRC screening and early detection, and fear of the procedure and of CRC. Patient navigation is an evidence-based approach to increasing colonoscopy completion. Patient navigation provides one-on-one support to patients preparing for and completing colonoscopy and addresses barriers through education, motivational interviewing, care coordination and connection to community resources. The effectiveness of patient navigation for increasing colonoscopy completion among low-income rural populations with positive FIT has not been demonstrated. The overall objective of this study is to test the effectiveness of a patient navigation program for increasing colonoscopy completion among rural, low-income populations who have had a positive FIT result. The project will be implemented in partnership with the Rural Health Council and the Washington Association for Community Health, and will engage four rural Federally Qualified Health Centers (FQHCs). The intervention will be evaluated in a type 1 hybrid implementation-effectiveness study that includes a 600-patient randomized controlled trial and comprehensive quantitative and qualitative data collection to better understand implementation and sustainability of the program. This project is critical in advancing our knowledge of the effectiveness of patient navigation for increasing colonoscopy in this patient population as well as for understanding factors that can support long term implementation and sustainability of effective interventions.

PROJECT NARRATIVE Colorectal cancer (CRC) remains a leading cause of cancer death in the United States. The objective of the Rural Community Support for Colonoscopy project is to test the effectiveness and study the implementation of a patient navigation program for increasing colonoscopy completion in rural populations with a positive fecal immunochemical test (FIT) result. The findings from this study will advance our knowledge of the effectiveness of patient navigation in this patient population and will guide future implementation and dissemination of the program.