181283 Barriers to completing colonoscopy screenings

Tuesday, October 28, 2008

Joseph Pare , College of Medicine, University of Vermont, Burlington, VT
Melinda Myzak, PhD , College of Medicine, University of Vermont, Burlington, VT
John Fialkovich , College of Medicine, University of Vermont, Burlington, VT
Adetola Fadeyibi , College of Medicine, University of Vermont, Burlington, VT
Mellory Giberson , College of Medicine, University of Vermont, Burlington, VT
Joseph Kaserman , College of Medicine, University of Vermont, Burlington, VT
Peter Lloyd , College of Medicine, University of Vermont, Burlington, VT
Greta Spottswood , College of Medicine, University of Vermont, Burlington, VT
Deborah Dameron , American Cancer Society, New England Division, Williston, VT
James Vecchio, MD , Fletcher Allen Health Care, Burlington, VT
Jan K. Carney, MD MPH , Department of Medicine, University of Vermont College of Medicine, Burlington, VT
Colon cancer is the second leading cause of cancer death in the United States. Early detection and removal of precancerous lesions through screening colonoscopy prevents colon cancer progression. Previous studies have shown that primary care physician (PCP) referral is a significant motivator for completing screening colonoscopies. Despite PCP referrals to colonoscopy clinics, a substantial number of patients do not complete their appointments. The objective of this study was to determine the factors that affect patient compliance with referred and scheduled colonoscopy screening appointments. Surveys were conducted among patients who were undergoing screening colonoscopies and patients who had missed their appointments (i.e. either did not follow up with scheduling or cancelled their appointment). Survey questions were directed at determining the barriers to attending colonoscopy appointments and the underlying reasons for scheduling the appointments. A significantly greater percentage of patients who did not complete their appointments reported encountering one or more barriers to scheduling or attending their appointments compared to those patients who completed their appointments (69%; 27%). The most statistically relevant barriers among the unscreened, when compared to successfully screened patients, included fear/embarrassment (34%; 7%), cost (28%; 4%), family commitments (10%; 1%), and time off from work (21%; 10%). Patients who completed their appointments were more likely to report health and/or other personal concerns as motivations beyond PCP referral for screening (41%; 15%). In order to improve colon cancer screening rates, we recommend focused patient education by physicians and social marketing in the areas of cost and fear and embarrassment.

Learning Objectives:
1. To determine strategies to increase patient compliance with recommended colon cancer screening procedures. 2. To better understand the barriers to completing colonoscopy screening appointments after referrals from primary care physicians. 3. To uncover specific deficient areas in patient education about the importance of screening in the prevention of colon cancer. 4. To determine patient populations at increased probability of missing a colonoscopy appointment.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conducted the research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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See more of: Epidemiology