Colorectal Cancer Screening Project | 2023-2_Barriers to follow up colonoscopy

Pdf Summary

In this document, Dr. Rachel Issaka discusses the barriers to colonoscopy after abnormal stool-based colorectal cancer screening. Several studies are referenced, showing the low completion rates of colonoscopy after abnormal stool-based tests. The barriers to follow-up are identified at different levels of care, including patient, provider, and healthcare system factors.<br /><br />Quantitative studies using electronic health records and surveys highlight patient-level barriers as the most prevalent. These barriers include patient-related, system-related, and provider-related factors. Provider-level barriers are found to differ depending on the type of stool-based test. System-level barriers, such as lack of referral and missed pre-procedure appointments, contribute to poor follow-up.<br /><br />Navigator-identified barriers reveal mismatches between identified barriers and navigation activities. Common barriers identified by navigators include lack of awareness about the screening process, cost or lack of insurance, and lack of reliable transportation.<br /><br />Qualitative studies, including interviews and focus groups, indicate that patient and provider beliefs, as well as health insurance, contribute to the lack of follow-up colonoscopy. Patient-identified barriers may differ across language groups.<br /><br />Mixed methods studies, combining quantitative and qualitative approaches, provide a more comprehensive understanding of barriers. These studies identify additional barriers, such as fear of colonoscopy, breakdown in communication, and COVID-19 related concerns.<br /><br />Overall, regardless of perspective, barriers to follow-up colonoscopy persist. These barriers include logistical factors, personal factors such as fear and concerns about the procedure, and financial factors such as lack of health insurance. Efforts to address these barriers are crucial to improving follow-up rates and ensuring timely and appropriate care for patients with abnormal stool-based colorectal cancer screening results.

Asset Subtitle

Rachel Issaka, MD, MAS

Keywords

colonoscopy

abnormal stool-based colorectal cancer screening

completion rates

barriers

patient-level barriers

provider-level barriers

system-level barriers

navigator-identified barriers

qualitative studies

mixed methods studies