Barriers to Colonoscopy Completion Span Multiple Realms

Lack of care coordination, lack of transportation, and fear of colonoscopies were among clinician-identified barriers to colonoscopy completion among patients with abnormal fecal immunochemical test (FIT) results in a safety net health care system, according to a qualitative study published online in JAMA Network Open.

“The effectiveness of stool-based colorectal cancer screening, including FITs, relies on colonoscopy completion among patients with abnormal results, but in safety net systems and federally qualified health centers, in which FIT is frequently used, colonoscopy completion within 1 year of an abnormal result rarely exceeds 50%,” wrote lead author Rachel B. Issaka, MD, of the Fred Hutchinson Cancer Research Center in Seattle, and coauthors.

To gain insight into barriers to colonoscopy competition in the patient population, researchers interviewed 21 primary care physicians and staff members from a large safety net health care system in Washington state.

All participants interviewed cited social determinants of health, organizational factors, and patient cognitive factors as barriers to colonoscopy completion, researchers reported.

In the category of social determinants of health, the most frequently identified barriers were lack of patient transportation (57.1%), language barriers (52.4%), and homelessness (38.1%). Organizational barriers included lack of care coordination between primary and specialty care clinics (28.6%), staffing shortages (19.%), and the COVID-19 pandemic (9.5%).

In the area of patient cognitive barriers, clinicians cited patient challenges with bowel preparation (61.9%), limited health literacy (47.6%), and fear of the procedure or a cancer diagnosis (42.9%).

When asked about factors that facilitated colonoscopy completion in the population, clinicians cited several interventions: adequate staffing of patient care coordinators (66.7%), care coordination across primary and specialty care clinics (57.1%), in-person follow-up appointments (47.6%), interpretation services (47.6%), patient appointment reminders (33.3%), patient education (33.3%), insurance assistance (28.6%), and transportation assistance (23.8%).

“Incorporating clinician-identified factors into multilevel interventions may be associated with improved colonoscopy completion among patients with abnormal FIT results,” researchers wrote, “and help address one of the most persistent challenges in cancer prevention and control for safety net and other medically underserved populations.”

—Jolynn Tumolo

Reference:

Issaka RB, Bell-Brown A, Snyder C, et al. Perceptions on barriers and facilitators to colonoscopy completion after abnormal fecal immunochemical test results in a safety net system. JAMA Network Open. 2021;4(8):e2120159.