Patient-Reported Barriers to Completing a Diagnostic Colonoscopy Following Abnormal Fecal Immunochemical Test Among Uninsured Patients

Abstract

BACKGROUND: For colorectal cancer (CRC) screening to improve survival, patients with an abnormal fecal immunochemical test (FIT) must follow-up with a diagnostic colonoscopy. Adherence to follow-up is low and patientlevel barriers for suboptimal adherence have yet to be explored. OBJECTIVE: To characterize barriers for non-completion of diagnostic colonoscopy after an abnormal FIT reported by under-and uninsured patients receiving care in a safety-net health system. DESIGN: A longitudinal, cohort study of CRC screening outreach to 8565 patients using mailed FIT kits. Patients with abnormal FIT results received telephonic navigation to arrange for a no-cost diagnostic colonoscopy. PATIENTS: Adults aged 50-64 years receiving care at a North Texas safety-net health system. APPROACH: Descriptive analyses characterized the patient sample and reasons for lack of follow-up after abnormal FIT over the 3-year outreach program. Thematic qualitative analyses characterized reasons for lack of follow-up with a colonoscopy after the abnormal FIT. KEY RESULTS: Of 689 patients with an abnormal FIT, 45% (n = 314) did not complete a follow-up colonoscopy. Among the 314 non-completers, 184 patients reported reasons for not completing a follow-up colonoscopy included health insurance-related challenges (38%), comorbid conditions (37%), social barriers such as transportation difficulties and lack of social support (29%), concerns about FIT/colonoscopy process (12%), competing life priorities (12%), adverse effects of bowel preparation (3%), and poor health literacy (3%). Among the 314 non-completers, 131 patients did not report a barrier, as 51% reported that that had completed a previous colonoscopy in the past 10 years, 10% refused with no reason, and 10% were never reached by phone.

Perceived Deterrence Towards Colonoscopy for Colorectal Cancer Screening among Northern Malaysia Population: A Qualitative Study

“…According to the report from Lithuania National Colorectal Cancer Screening Program, only 52.4% of the iFOBT-positive individuals undergo colonoscopy, resulting in a meagre colorectal cancer detection rate (Poskus et al, 2015). Other reported factors that discourage patient from undergoing colonoscopy were comorbid conditions, competing life priorities, transportation difficulties and lack of social support (Jetelina et al, 2019).…”

Development of a Multivariable Prediction Model to Identify Patients Unlikely to Complete a Colonoscopy Following an Abnormal FIT Test in Community Clinics

“…Barriers can inhibit patients' ability to complete this follow-up colonoscopy. Patient-level barriers to completing a follow-up colonoscopy may include fear of results, inability to take time off of work, the cost of preparation supplies or the colonoscopy, inability to complete adequate bowel prep, difficulty finding a driver on the day of the procedure, having competing health concerns, and lack of understanding that the procedure was necessary (7,10,13,14).…”

Development of a multivariable prediction model to identify patients unlikely to complete a colonoscopy following an abnormal FIT test in community clinics

“…For these patients, a follow-up colonoscopy is recommended, yet rates of completion of the follow-up colonoscopy remain low [ 5 – 7 ]. Among patients who receive care in community clinics in the United States, follow-up colonoscopy rates are consistently as low as 50% [ 7 – 10 ]. Liss and Chubak have identified rates of achieving a follow-up colonoscopy after an abnormal FIT test of 54 and 50% respectively in community health center patients [ 11 , 12 ].…”