Barriers to Follow-up Colonoscopies for Patients With Positive Results From Fecal Immunochemical Tests During Colorectal Cancer Screening
| Autor: | Nimah Jamaluddin, Folasade P. May, Elizabeth M. Yano, Lisa D. Lin, Christine Yu, Julian Brunner, Purnima Bharath, Dawn Provenzale, Jennifer Phan, Tina R. Storage, Dean Ehrlich, Doantrang Dinh, Elizabeth S. Aby, Donna L. Washington |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Colorectal cancer Colonoscopy California Feces 03 medical and health sciences 0302 clinical medicine Interquartile range Internal medicine Epidemiology Humans Medicine Veterans Affairs Early Detection of Cancer Aged Retrospective Studies Veterans Hepatology medicine.diagnostic_test Diagnostic Tests Routine business.industry Gastroenterology Middle Aged medicine.disease Cross-Sectional Studies Colorectal cancer screening 030220 oncology & carcinogenesis Cohort Female 030211 gastroenterology & hepatology Colorectal Neoplasms business Facilities and Services Utilization |
| Zdroj: | Clinical Gastroenterology and Hepatology. 17:469-476 |
| ISSN: | 1542-3565 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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