Editorial links transportation barriers with disparities in diagnostic colonoscopy access

A systematic review and meta-analysis found that patient navigation was associated with clinically meaningful improvements in diagnostic colonoscopy completion after positive stool-based colorectal cancer screening tests, according to an editorial in the Journal of General Internal Medicine. The review examined factors affecting completion of the second step in screening, with particular attention to populations experiencing health disparities.

The review addressed an evidence gap. Much of the literature on organized colorectal cancer screening has focused on whether patients complete the initial stool-based test, while fewer studies have examined diagnostic colonoscopy completion after an abnormal result. Gonzalez Mosquera and colleagues reviewed existing literature on interventions and factors associated with completing diagnostic colonoscopy following positive stool-based tests.

The review reported moderate-certainty evidence that patient navigation was associated with higher diagnostic colonoscopy completion rates. Navigators can help communicate abnormal results, assist with scheduling and educate patients. The accompanying editorial also emphasized transportation and discharge requirements as an upstream consideration that health systems may overlook when arranging follow-up care.

Access to diagnostic colonoscopy can be complicated by hospital and ambulatory procedure unit policies requiring patients to receive moderate sedation and be accompanied home by a responsible adult. The editorial stated that such requirements may create obstacles for people without adequate social support, including some patients facing racial, ethnic or socioeconomic disparities. The source did not present controlled evidence showing that removing escort policies increases colonoscopy completion or that such policies prevent patients from obtaining the procedure.

The authors proposed case-by-case evaluation of discharge needs and advance planning rather than a one-size-fits-all escort requirement. The editorial noted that evidence cited in the piece did not substantiate an effect of personal-escort policies on procedure-related complication rates, while emphasizing the need for more methodologically robust studies of patient-safety outcomes. It presented sound physician judgment and shared decision-making, including informed consent before the procedure when feasible, as central to discharge planning.

Planning should begin before patients arrive for endoscopy, according to the editorial. Patient navigators could help arrange public transportation or low-cost ride-share services, communicate with gastroenterology teams and serve as contacts if procedure- or sedation-related complications occur after discharge. Early scheduling may provide more time for recovery from sedation before discharge home. The authors also called for access to bilingual navigators because language barriers and poor health literacy can complicate transportation planning.

For patients who do not have an escort, clinical teams can assess cognition, balance and alertness to guide discharge decisions. The editorial names the Aldrete Scoring System, Post-Anesthesia Discharge Scoring System and Modified Observer’s Assessment of Alertness/Sedation as examples of standardized assessments. It also cites Young v. Gastro-Intestinal Center, in which a patient with decisional capacity left a procedure unit against medical advice after moderate sedation and later died in a single-vehicle crash; the court did not hold the gastroenterologist liable.

Health systems may also explore discounted partnerships with ride-share companies, with rides requested by patients or hospital staff and potentially billed directly to insurance plans. These approaches are presented as potential ways to support same-day discharge amid rising costs and diminishing reimbursements, without implying that transportation policies have already been shown to improve outcomes. The editorial’s bounded conclusion is that expanding navigation to address transportation may help reduce barriers to timely diagnostic colonoscopy, particularly for disadvantaged patients without a ride home; the strongest reported evidence concerns patient navigation overall rather than the comparative effectiveness of specific transportation or escort policies.

Subject of Research: Patient navigation and transportation barriers affecting diagnostic colonoscopy completion after positive stool-based colorectal cancer screening

Article Title: When Patients Have No Ride Home: Addressing Transportation Barriers That Exacerbate Disparities in Access to Timely Diagnostic Colonoscopies

Article References: Martz, K., & Hwang, C. S. (2026). When Patients Have No Ride Home: Addressing Transportation Barriers That Exacerbate Disparities in Access to Timely Diagnostic Colonoscopies. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10889-3

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10889-3

Keywords: colorectal cancer screening, diagnostic colonoscopy, patient navigation, transportation barriers, health disparities, moderate sedation, discharge planning, ride-share services, Patients, Ride, Home, Addressing