Katelyn K Jetelina1, Joshua S Yudkin2, Stacie Miller3,4, Emily Berry3,4, Alicea Lieberman5, Samir Gupta6, Bijal A Balasubramanian2,3,4. 1. Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, School of Public Health, 6011 Harry Hines Blvd. V8.112, Dallas, TX, 75390, USA. Katelyn.k.jetelina@uth.tmc.edu. 2. Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, School of Public Health, 6011 Harry Hines Blvd. V8.112, Dallas, TX, 75390, USA. 3. Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA. 4. Moncrief Cancer Center, Fort Worth, TX, USA. 5. Rady School of Management, University of California, San Diego, San Diego, CA, USA. 6. Department of Internal Medicine, University of California, San Diego, San Diego, CA, USA.
Abstract
BACKGROUND: For colorectal cancer (CRC) screening to improve survival, patients with an abnormal fecal immunochemical test (FIT) must follow-up with a diagnostic colonoscopy. Adherence to follow-up is low and patient-level barriers for suboptimal adherence have yet to be explored. OBJECTIVE: To characterize barriers for non-completion of diagnostic colonoscopy after an abnormal FIT reported by under- and uninsured patients receiving care in a safety-net health system. DESIGN: A longitudinal, cohort study of CRC screening outreach to 8565 patients using mailed FIT kits. Patients with abnormal FIT results received telephonic navigation to arrange for a no-cost diagnostic colonoscopy. PATIENTS: Adults aged 50-64 years receiving care at a North Texas safety-net health system. APPROACH: Descriptive analyses characterized the patient sample and reasons for lack of follow-up after abnormal FIT over the 3-year outreach program. Thematic qualitative analyses characterized reasons for lack of follow-up with a colonoscopy after the abnormal FIT. KEY RESULTS: Of 689 patients with an abnormal FIT, 45% (n = 314) did not complete a follow-up colonoscopy. Among the 314 non-completers, 184 patients reported reasons for not completing a follow-up colonoscopy included health insurance-related challenges (38%), comorbid conditions (37%), social barriers such as transportation difficulties and lack of social support (29%), concerns about FIT/colonoscopy process (12%), competing life priorities (12%), adverse effects of bowel preparation (3%), and poor health literacy (3%). Among the 314 non-completers, 131 patients did not report a barrier, as 51% reported that that had completed a previous colonoscopy in the past 10 years, 10% refused with no reason, and 10% were never reached by phone. CONCLUSIONS: Future studies aimed at improving FIT screening and subsequent colonoscopy rates need to address the unique needs of patients for effective and sustainable screening programs. TRIAL REGISTRATION: NCT01946282.
BACKGROUND: For colorectal cancer (CRC) screening to improve survival, patients with an abnormal fecal immunochemical test (FIT) must follow-up with a diagnostic colonoscopy. Adherence to follow-up is low and patient-level barriers for suboptimal adherence have yet to be explored. OBJECTIVE: To characterize barriers for non-completion of diagnostic colonoscopy after an abnormal FIT reported by under- and uninsured patients receiving care in a safety-net health system. DESIGN: A longitudinal, cohort study of CRC screening outreach to 8565 patients using mailed FIT kits. Patients with abnormal FIT results received telephonic navigation to arrange for a no-cost diagnostic colonoscopy. PATIENTS: Adults aged 50-64 years receiving care at a North Texas safety-net health system. APPROACH: Descriptive analyses characterized the patient sample and reasons for lack of follow-up after abnormal FIT over the 3-year outreach program. Thematic qualitative analyses characterized reasons for lack of follow-up with a colonoscopy after the abnormal FIT. KEY RESULTS: Of 689 patients with an abnormal FIT, 45% (n = 314) did not complete a follow-up colonoscopy. Among the 314 non-completers, 184 patients reported reasons for not completing a follow-up colonoscopy included health insurance-related challenges (38%), comorbid conditions (37%), social barriers such as transportation difficulties and lack of social support (29%), concerns about FIT/colonoscopy process (12%), competing life priorities (12%), adverse effects of bowel preparation (3%), and poor health literacy (3%). Among the 314 non-completers, 131 patients did not report a barrier, as 51% reported that that had completed a previous colonoscopy in the past 10 years, 10% refused with no reason, and 10% were never reached by phone. CONCLUSIONS: Future studies aimed at improving FIT screening and subsequent colonoscopy rates need to address the unique needs of patients for effective and sustainable screening programs. TRIAL REGISTRATION: NCT01946282.
Authors: Samir Gupta; Daniel A Sussman; Chyke A Doubeni; Daniel S Anderson; Lukejohn Day; Amar R Deshpande; B Joseph Elmunzer; Adeyinka O Laiyemo; Jeanette Mendez; Ma Somsouk; James Allison; Taft Bhuket; Zhuo Geng; Beverly B Green; Steven H Itzkowitz; Maria Elena Martinez Journal: J Natl Cancer Inst Date: 2014-03-28 Impact factor: 13.506
Authors: Rachel B Issaka; Maneesh H Singh; Sachiko M Oshima; Victoria J Laleau; Carly D Rachocki; Ellen H Chen; Lukejohn W Day; Urmimala Sarkar; Ma Somsouk Journal: Am J Gastroenterol Date: 2016-12-13 Impact factor: 10.864
Authors: Jason Martin; Ethan A Halm; Jasmin A Tiro; Zahra Merchant; Bijal A Balasubramanian; Katharine McCallister; Joanne M Sanders; Chul Ahn; Wendy Pechero Bishop; Amit G Singal Journal: Am J Med Date: 2016-08-31 Impact factor: 4.965
Authors: Ashwin N Ananthakrishnan; Kenneth G Schellhase; Rodney A Sparapani; Purushottam W Laud; Joan M Neuner Journal: Arch Intern Med Date: 2007-02-12
Authors: Idris Guessous; Chiranjeev Dash; Pauline Lapin; Mary Doroshenk; Robert A Smith; Carrie N Klabunde Journal: Prev Med Date: 2009-12-16 Impact factor: 4.018
Authors: L Hol; M E van Leerdam; M van Ballegooijen; A J van Vuuren; H van Dekken; J C I Y Reijerink; A C M van der Togt; J D F Habbema; E J Kuipers Journal: Gut Date: 2010-01 Impact factor: 23.059
Authors: Douglas A Corley; Christopher D Jensen; Virginia P Quinn; Chyke A Doubeni; Ann G Zauber; Jeffrey K Lee; Joanne E Schottinger; Amy R Marks; Wei K Zhao; Nirupa R Ghai; Alexander T Lee; Richard Contreras; Charles P Quesenberry; Bruce H Fireman; Theodore R Levin Journal: JAMA Date: 2017-04-25 Impact factor: 56.272
Authors: Shahnaz Sultan; Melissa R Partin; Phalgoon Shah; Jennifer LeLaurin; Ivette Magaly Freytes; Chandylen L Nightingale; Susan F Fesperman; Barbara A Curbow; Rebecca J Beyth Journal: Patient Prefer Adherence Date: 2017-05-24 Impact factor: 2.711
Authors: Rachel B Issaka; Ari Bell-Brown; Jason Kao; Cyndy Snyder; Dana L Atkins; Lisa D Chew; Bryan J Weiner; Lisa Strate; John M Inadomi; Scott D Ramsey Journal: Prev Med Rep Date: 2022-05-18
Authors: Samir Gupta; Gloria D Coronado; Keith Argenbright; Alison T Brenner; Sheila F Castañeda; Jason A Dominitz; Beverly Green; Rachel B Issaka; Theodore R Levin; Daniel S Reuland; Lisa C Richardson; Douglas J Robertson; Amit G Singal; Michael Pignone Journal: CA Cancer J Clin Date: 2020-06-25 Impact factor: 286.130
Authors: Amanda F Petrik; Erin Keast; Eric S Johnson; David H Smith; Gloria D Coronado Journal: BMC Health Serv Res Date: 2020-11-10 Impact factor: 2.655
Authors: Mathias M Petersen; Linnea Ferm; Jakob Kleif; Thomas B Piper; Eva Rømer; Ib J Christensen; Hans J Nielsen Journal: Cancers (Basel) Date: 2020-09-12 Impact factor: 6.639
Authors: Beverly B Green; Laura-Mae Baldwin; Imara I West; Malaika Schwartz; Gloria D Coronado Journal: J Prim Care Community Health Date: 2020 Jan-Dec
Authors: Ashley C Mog; Peter S Liang; Lucas M Donovan; George G Sayre; Aasma Shaukat; Folasade P May; Thomas J Glorioso; Michelle A Jorgenson; Gordon Blake Wood; Candice Mueller; Jason A Dominitz Journal: Clin Transl Gastroenterol Date: 2022-02-01 Impact factor: 4.396