Patient factors associated with non-attendance at colonoscopy after a positive screening faecal occult blood test

Abstract

Background Screening participants with abnormal faecal occult blood test results who do not attend further testing are at high risk of colorectal cancer, yet little is known about their reasons for non-attendance. Methods We conducted a medical record review of 170 patients from two English Bowel Cancer Screening Programme centres who had abnormal guaiac faecal occult blood test screening tests between November 2011 and April 2013 but did not undergo colonoscopy. Using information from patient records, we coded and categorized reasons for non-attendance. Results Of the 170 patients, 82 were eligible for review, of whom 66 had at least one recorded reason for lack of colonoscopy follow-up. Reasons fell into seven main categories: (i) other commitments, (ii) unwillingness to have the test, (iii) a feeling that the faecal occult blood test result was a false positive, (iv) another health issue taking priority, (v) failing to complete bowel preparation, (vi) practical barriers (e.g. lack of transport), and (vii) having had or planning colonoscopy elsewhere. The most common single reasons were unwillingness to have a colonoscopy and being away. Conclusions We identify a range of apparent reasons for colonoscopy non-attendance after a positive faecal occult blood test screening. Education regarding the interpretation of guaiac faecal occult blood test findings, offer of alternative confirmatory test options, and flexibility in the timing or location of subsequent testing might decrease non-attendance of diagnostic testing following positive faecal occult blood test.

Factors affecting compliance with confirmatory colonoscopy after a positive fecal immunochemical test in a national colorectal screening program

“…Cues for action, including “physician's recommendation”; “family history of colorectal cancer”; “experience of bowel habit change or other's experience of undergoing colonoscopy”; and “ past history of tarry stool, bloody stool, or any bowel habit change,” had a great impact on individual's willingness to undergo colonoscopy. These findings were consistent with previous studies . In Taiwan, many physicians are not familiar with the benefits of FIT screening, are unaware of its improved performance compared with the chemical FOBT, and have a doubtful attitude about the result.…”

“…These findings were consistent with previous studies. [22][23][24][25] In Taiwan, many physicians are not familiar with the benefits of FIT screening, are unaware of its improved performance compared with the chemical FOBT, and have a doubtful attitude about the result. Because of this lack of knowledge, many FIT-positive patients are told that it is "not necessary to undergo colonoscopy" or that the FIT test was repeated by their physician, as reported by 4% of our study population.…”

Contribution of patient, physician, and environmental factors to demographic and health variation in colonoscopy follow‐up for abnormal colorectal cancer screening test results

“…Potentially inappropriate screening because of limited life expectancy was relatively rare in our sample (<1%), as also documented in prior studies conducted in samples ages 50 to 75 years . The frequency of refusal among those who failed to complete a colonoscopy we observed (14%‐21%, depending on whether those who refused are combined with those who both refused and had private sector colonoscopy access) was similar to colonoscopy follow‐up refusal rates reported in prior studies (range, 7%‐26%) …”

“…23 The frequency of refusal among those who failed to complete a colonoscopy we observed (14%-21%, depending on whether those who refused are combined with those who both refused and had private sector colonoscopy access) was similar to colonoscopy follow-up refusal rates reported in prior studies (range, 7%-26%). 12,16,17,24,25 Although prior studies have documented lower rates of colorectal cancer screening 26 and surveillance 27 among racial and ethnic minority groups, findings regarding race/ethnic variation in colonoscopy follow-up for positive FOBT/FIT results are mixed. One prior study conducted in a community practice 12 reported lower followup rates among Hispanics, but most prior studies have reported either no evidence of race/ethnic variation in follow-up 5,10,28 or higher follow-up rates among minorities.…”

Repeated Automated Mobile Text Messaging Reminders for Follow-Up of Positive Fecal Occult Blood Tests: Randomized Controlled Trial (Preprint)

“…Barriers to follow-up after a positive FOBT have been identified in the literature [17][18][19][20][21][22] and are divided into four general groups based on whether they are related to patients, physicians, providers, or information technology [23][24][25]. Intervention programs have been developed to target each of these groups [26].…”