Barriers to Follow-up Colonoscopies for Patients With Positive Results From Fecal Immunochemical Tests During Colorectal Cancer Screening

Folasade P. May, Elizabeth M. Yano, Dawn Provenzale, Julian Brunner, Christine Yu, Jennifer Phan, Purnima Bharath, Elizabeth Aby, Doantrang Dinh, Dean S. Ehrlich, Tina R. Storage, Lisa D. Lin, Nimah N. Jamaluddin, Donna L. Washington

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)469-476
Number of pages8
JournalClinical Gastroenterology and Hepatology
Volume17
Issue number3
DOIs
StatePublished - Feb 2019

Bibliographical note

Funding Information:
Funding Supported by a Veterans Affairs Health Services Research and Development Senior Research Career Scientist Award (project RCS 05-195) (E.M.Y.); support for analyses was provided by the VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy , VA Greater Los Angeles Healthcare System (project CIN 13-417); and also supported by the VA Greater Los Angeles Healthcare System Department of Medicine and Division of Gastroenterology (F.M.). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government.

Publisher Copyright:
© 2019 AGA Institute

Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.

Keywords

  • Colon Cancer
  • Epidemiology
  • Prevention
  • Quality

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