Predictors of nonadherence to screening colonoscopy
Predictors of nonadherence to screening colonoscopy
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DOI：
10.1111/j.1525-1497.2005.00164.x
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发表时间：
2005-11-01
影响因子：
5.7
通讯作者：
Ahnen, DJ
中科院分区：
文献类型：
--
作者：
Denberg, TD;Melhado, TV;Ahnen, DJ
背景：结肠镜检查已成为首选的结直肠癌（CRC）筛查方式。很少有人知道为什么被转诊接受结肠镜检查的患者没有完成推荐的程序。先前的依从性研究评估结肠镜检查仅结合灵活的乙状结肠镜检查，未能区分筛选和诊断程序，并检查取消/无显示，但不nonscheduling，作为机制的nonadherence.METHODS：社会人口统计学的预测因素筛选完成了评估，在一个回顾性队列的647例结肠镜检查的患者在一个主要的大学医院。然后，使用定性研究设计，一个方便的样本的患者谁从来没有完成筛选后转介（n=52）进行了电话采访，并在报告的原因不遵守gender.RESULTS：一半的结肠镜检查的所有患者未能完成的程序，绝大多数是因为nonscheduling。在多变量分析中，女性性别，年轻的年龄，和保险类型预测较差的坚持。患者报告的完成筛选的障碍包括认知-情感因素（例如，缺乏对CRC的感知风险、对疼痛的恐惧以及对谦虚和肠道准备的关注），逻辑障碍（例如，成本、其他健康问题和竞争性需求），以及卫生系统障碍（例如，排程挑战、长等待时间）。妇女报告说，她们比男子更关心手术的端庄和其他方面。只有40%的患者知道的替代筛查options.CONCLUSIONS：坚持筛查结肠镜转诊是次优，并可能会改善更好地与患者沟通，咨询，以帮助解决后勤障碍，并改善结肠镜转诊和调度机制。
BACKGROUND: Colonoscopy has become a preferred colorectal cancer (CRC) screening modality. Little is known about why patients who are referred for colonoscopy do not complete the recommended procedures. Prior adherence studies have evaluated colonoscopy only in combination with flexible sigmoidoscopy, failed to differentiate between screening and diagnostic procedures, and have examined cancellations/no-shows, but not nonscheduling, as mechanisms of nonadherence.METHODS: Sociodemographic predictors of screening completion were assessed in a retrospective cohort of 647 patients referred for colonoscopy at a major university hospital. Then, using a qualitative study design, a convenience sample of patients who never completed screening after referral (n=52) was interviewed by telephone, and comparisons in reported reasons for nonadherence were made by gender.RESULTS: Half of all patients referred for colonoscopy failed to complete the procedure, overwhelmingly because of nonscheduling. In multivariable analysis, female sex, younger age, and insurance type predicted poorer adherence. Patient-reported barriers to screening completion included cognitive-emotional factors (e.g., lack of perceived risk for CRC, fear of pain, and concerns about modesty and the bowel preparation), logistic obstacles (e.g., cost, other health problems, and competing demands), and health system barriers (e.g., scheduling challenges, long waiting times). Women reported more concerns about modesty and other aspects of the procedure than men. Only 40% of patients were aware of alternative screening options.CONCLUSIONS: Adherence to screening colonoscopy referrals is sub-optimal and may be improved by better communication with patients, counseling to help resolve logistic barriers, and improvements in colonoscopy referral and scheduling mechanisms.