TY - JOUR
T1 - Barriers to Follow-up Colonoscopies for Patients With Positive Results From Fecal Immunochemical Tests During Colorectal Cancer Screening
AU - May, Folasade P.
AU - Yano, Elizabeth M.
AU - Provenzale, Dawn
AU - Brunner, Julian
AU - Yu, Christine
AU - Phan, Jennifer
AU - Bharath, Purnima
AU - Aby, Elizabeth
AU - Dinh, Doantrang
AU - Ehrlich, Dean S.
AU - Storage, Tina R.
AU - Lin, Lisa D.
AU - Jamaluddin, Nimah N.
AU - Washington, Donna L.
N1 - Publisher Copyright:
© 2019 AGA Institute
PY - 2019/2
Y1 - 2019/2
N2 - Background & Aims: Colorectal cancer is common yet largely preventable. The fecal immunochemical test (FIT) is a highly recommended screening method, but patients with positive results must receive a follow-up colonoscopy to determine if they have precancerous or cancerous lesions. We characterized colonoscopic follow-up evaluations and reasons for lack of follow-up in a Veterans Affairs (VA) cohort. Methods: We conducted a retrospective cross-sectional analysis of patients 50 to 75 years old with a positive FIT result from January 1, 2014, through May 31, 2016, in a network of 12 VAs sites in southern California. We determined the proportion of patients who received a follow-up colonoscopy, median time to colonoscopy, and colonoscopy findings. For patients who did not undergo colonoscopy, we determined the documented reason for lack of colonoscopy and factors associated with declining the colonoscopy examination. Results: Of the 10,635 FITs performed, 916 (8.6%) produced positive results; 569 of these (62.1%) were followed by colonoscopy. The median time to colonoscopy after a positive FIT result was 83 days (interquartile range, 54–145 d), which did not vary between veterans who received a colonoscopy at a VA facility (81 d; interquartile range, 52–143 d) vs a non-VA site (87 d; interquartile range, 60–154 d) (P =.2). For the 347 veterans (37.9%) who did not undergo follow-up colonoscopy, the reasons were patient-related (49.3%), provider-related (16.4%), system-related (12.1%), or multifactorial (22.2%). Overall, patient decline of colonoscopy (35.2%) was the most common reason. Conclusions: In a cohort of veterans with positive results from FITs during CRC screening, reasons for lack of follow-up colonoscopy varied and included patient, provider, and system factors. These findings can be used to reduce barriers to follow-up colonoscopy and to address system-level challenges in scheduling and attrition for colonoscopy.
AB - Background & Aims: Colorectal cancer is common yet largely preventable. The fecal immunochemical test (FIT) is a highly recommended screening method, but patients with positive results must receive a follow-up colonoscopy to determine if they have precancerous or cancerous lesions. We characterized colonoscopic follow-up evaluations and reasons for lack of follow-up in a Veterans Affairs (VA) cohort. Methods: We conducted a retrospective cross-sectional analysis of patients 50 to 75 years old with a positive FIT result from January 1, 2014, through May 31, 2016, in a network of 12 VAs sites in southern California. We determined the proportion of patients who received a follow-up colonoscopy, median time to colonoscopy, and colonoscopy findings. For patients who did not undergo colonoscopy, we determined the documented reason for lack of colonoscopy and factors associated with declining the colonoscopy examination. Results: Of the 10,635 FITs performed, 916 (8.6%) produced positive results; 569 of these (62.1%) were followed by colonoscopy. The median time to colonoscopy after a positive FIT result was 83 days (interquartile range, 54–145 d), which did not vary between veterans who received a colonoscopy at a VA facility (81 d; interquartile range, 52–143 d) vs a non-VA site (87 d; interquartile range, 60–154 d) (P =.2). For the 347 veterans (37.9%) who did not undergo follow-up colonoscopy, the reasons were patient-related (49.3%), provider-related (16.4%), system-related (12.1%), or multifactorial (22.2%). Overall, patient decline of colonoscopy (35.2%) was the most common reason. Conclusions: In a cohort of veterans with positive results from FITs during CRC screening, reasons for lack of follow-up colonoscopy varied and included patient, provider, and system factors. These findings can be used to reduce barriers to follow-up colonoscopy and to address system-level challenges in scheduling and attrition for colonoscopy.
KW - Colon Cancer
KW - Epidemiology
KW - Prevention
KW - Quality
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UR - http://www.scopus.com/inward/citedby.url?scp=85060272040&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2018.05.022
DO - 10.1016/j.cgh.2018.05.022
M3 - Article
C2 - 29857147
AN - SCOPUS:85060272040
SN - 1542-3565
VL - 17
SP - 469
EP - 476
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 3
ER -