Folasade P May1, Elizabeth M Yano2, Dawn Provenzale3, Julian Brunner2, Christine Yu4, Jennifer Phan4, Purnima Bharath5, Elizabeth Aby4, Doantrang Dinh4, Dean S Ehrlich4, Tina R Storage4, Lisa D Lin4, Nimah N Jamaluddin4, Donna L Washington6. 1. Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California; The University of California Los Angeles Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, University of California David Geffen School of Medicine, Los Angeles, California; Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, California. Electronic address: fmay@mednet.ucla.edu. 2. Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, California; Department of Health Policy and Management, Fielding School of Public Health, Los Angeles, California. 3. VA Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center, Durham, North Carolina; Department of Medicine, Duke University Medical Center, Durham, North Carolina. 4. The University of California Los Angeles Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, University of California David Geffen School of Medicine, Los Angeles, California. 5. Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California; Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, California. 6. Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California; Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, California; Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles, Los Angeles, California.
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.
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.
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