Barriers to Follow-up Colonoscopies for Patients With Positive Results From Fecal Immunochemical Tests During Colorectal Cancer Screening
Barriers to Follow-up Colonoscopies for Patients With Positive Results From Fecal Immunochemical Tests During Colorectal Cancer Screening
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DOI：
10.1016/j.cgh.2018.05.022
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发表时间：
2019-02-01
影响因子：
12.6
通讯作者：
Washington, Donna L.
中科院分区：
文献类型：
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作者：
May, Folasade P.;Yano, Elizabeth M.;Washington, Donna L.
背景与目的：结直肠癌很常见，但在很大程度上是可以预防的。粪便免疫化学测试（FIT）是强烈推荐的筛查方法，但结果呈阳性的患者必须接受后续结肠镜检查，以确定是否患有癌前或癌性病变。我们对退伍军人事务部 (VA) 队列的结肠镜随访评估和缺乏随访的原因进行了描述。 方法：我们对 2014 年 1 月 1 日至 2016 年 5 月 31 日期间 FIT 结果呈阳性的 50 至 75 岁患者在南加州 12 个 VA 站点网络中进行了回顾性横断面分析。我们确定了接受结肠镜检查随访的患者比例、结肠镜检查的中位时间以及结肠镜检查结果。对于未接受结肠镜检查的患者，我们确定了未接受结肠镜检查的记录原因以及拒绝接受结肠镜检查的相关因素。 结果：在进行的 10,635 例 FIT 中，916 例 (8.6%) 产生阳性结果；916 例 (8.6%) 产生阳性结果；916 例 (8.6%) 产生阳性结果。其中 569 例 (62.1%) 接受了结肠镜检查。 FIT 结果呈阳性后进行结肠镜检查的中位时间为 83 天（四分位距，54-145 天），在 VA 机构接受结肠镜检查的退伍军人（81 天；四分位距，52-143 天）与非 VA 机构接受结肠镜检查的退伍军人（87 天；四分位距，60-154 天）之间没有差异（P=.2）。对于 347 名退伍军人 (37.9%) 没有接受后续结肠镜检查的原因，其原因包括患者相关 (49.3%)、提供者相关 (16.4%)、系统相关 (12.1%) 或多因素 (22.2%)。总体而言，患者拒绝接受结肠镜检查 (35.2%) 是最常见的原因。 结论：在 CRC 筛查期间 FIT 呈阳性结果的退伍军人队列中，缺乏后续结肠镜检查的原因各不相同，包括患者、提供者和系统因素。这些发现可用于减少后续结肠镜检查的障碍，并解决结肠镜检查安排和人员流失方面的系统级挑战。
BACKGROUND & AIMS: Colorectal cancer is common yet largely preventable. The fecal immunochemical test (FIT) is a highly recommended screeningmethod, but patientswith positive resultsmust 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 betweenveteranswho received a colonoscopy at a VAfacility (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.