Underuse of surveillance colonoscopy in patients at increased risk of colorectal cancer.
Underuse of surveillance colonoscopy in patients at increased risk of colorectal cancer.
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DOI：
10.1038/ajg.2014.344
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发表时间：
2015-05
影响因子：
9.8
通讯作者：
Sandler, Robert S.
中科院分区：
文献类型：
--
作者：
Murphy, Caitlin C.;Lewis, Carmen L.;Golin, Carol E.;Sandler, Robert S.
结直肠癌的发病率和死亡率在过去二十年中有所下降，这在很大程度上归功于筛查的增加。大约25%接受结肠镜检查的患者有癌前腺瘤，需要切除和随访结肠镜检查。然而，很少有研究使用监测结肠镜检查的风险增加的患者与以前的腺瘤。我们进行了一项横断面研究，以检查与结直肠癌风险增加的患者中监测结肠镜检查使用不足相关的因素。研究人群包括先前发现的腺瘤性息肉患者和应进行随访结肠镜检查的患者。根据随访结肠镜检查的完成情况，将患者分为参加者（n=100）或非参加者（n=104）。电话调查评估了监测结肠镜检查在易感患者特征、促成因素和患者需求方面的应用。多变量逻辑回归用于确定与筛选完成相关的因素。感知障碍、感知益处、社会剥夺和癌症担忧与结肠镜检查的出席率相关。更高的效益（比值比（OR）2.37，95%可信区间（CI）1.04-5.41）与癌症担忧（OR 1.73，95% CI 1.07-2.79）增加了随访结肠镜检查的机会，而更大的障碍（OR 0.49，95% CI 0.28-0.88）和高度社会剥夺（≥2; OR 0.09，95% CI 0.01-0.76）与较低的几率相关。我们的研究结果表明，多层次的因素有助于在高危人群中使用监测结肠镜检查，其中许多是适合干预。干预措施，如患者导航，可能有助于促进监测结肠镜检查的适当使用。
Colorectal cancer incidence and mortality have declined over the past two decades, and much of this improvement is attributed to increased use of screening. Approximately 25% of patients who undergo screening colonoscopy have premalignant adenomas that require removal and follow-up colonoscopy. However, there are few studies of the use of surveillance colonoscopy in increased risk patients with previous adenomas. We conducted a cross-sectional study to examine factors associated with underuse of surveillance colonoscopy among patients who are at increased risk for colorectal cancer. The study population consisted of patients with previously identified adenomatous polyps and who were due for follow-up colonoscopy. Patients were categorized as attenders (n=100) or non-attenders (n=104) on the basis of completion of follow-up colonoscopy. Telephone surveys assessed the use of surveillance colonoscopy across domains of predisposing patient characteristics, enabling factors, and patient need. Mutlivariable logistic regression was used to identify factors associated with screening completion. Perceived barriers, perceived benefits, social deprivation, and cancer worry were associated with attendance at colonoscopy. Higher benefits (odds ratio (OR) 2.37, 95% confidence interval (CI) 1.04–5.41) and cancer worry (OR 1.73, 95% CI 1.07–2.79) increased the odds of attendance at follow-up colonoscopy, whereas greater barriers (OR 0.49, 95% CI 0.28–0.88) and high social deprivation (≥2; OR 0.09, 95% CI 0.01–0.76) were associated with lower odds. Our results suggest that multilevel factors contribute to the use of surveillance colonoscopy in higher risk populations, many of which are amenable to intervention. Interventions, such as patient navigation, may help facilitate appropriate use of surveillance colonoscopy.
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影响因子：
4.4
作者：
Hay, Jennifer;Coups, Elliot;Ford, Jennifer
通讯作者：
Ford, Jennifer
影响因子：
5.1
作者：
Janz, NK;Wren, PA;Guire, KE
通讯作者：
Guire, KE
影响因子：
3.8
作者：
Ritvo, Paul;Myers, Ronald;Rabeneck, Linda
通讯作者：
Rabeneck, Linda
DOI：
10.1111/j.1532-5415.1983.tb03391.x
发表时间：
1983-01-01
影响因子：
6.3
作者：
KATZ, S
通讯作者：
KATZ, S
影响因子：
5
作者：
ANDERSEN, RM
通讯作者：
ANDERSEN, RM