Patient-Reported Barriers to Completing a Diagnostic Colonoscopy Following Abnormal Fecal Immunochemical Test Among Uninsured Patients
Patient-Reported Barriers to Completing a Diagnostic Colonoscopy Following Abnormal Fecal Immunochemical Test Among Uninsured Patients
复制标题
DOI：
10.1007/s11606-019-05117-0
复制
发表时间：
2019-09-01
影响因子：
5.7
通讯作者：
Balasubramanian, Bijal A.
中科院分区：
文献类型：
--
作者：
Jetelina, Katelyn K.;Yudkin, Joshua S.;Balasubramanian, Bijal A.
背景：为了提高生存率，结肠直肠癌（CRC）筛查，粪便免疫化学试验（FIT）异常的患者必须进行诊断性结肠镜检查。对随访的依从性较低，尚未探索次优依从性的患者水平障碍。目的描述在安全网卫生系统中接受治疗的未参保和未参保患者报告的异常FIT后未完成诊断性结肠镜检查的障碍。设计：一项使用邮寄FIT试剂盒对8565例患者进行CRC筛查的纵向队列研究。FIT结果异常的患者接受电话导航，以安排免费的诊断性结肠镜检查。患者50-64岁的成年人在北德克萨斯州安全网卫生系统接受护理。方法描述性分析患者样本的特点和原因缺乏后续异常后，FIT超过3年的推广计划。专题定性分析的特点，缺乏后续的原因与结肠镜检查后，异常FIT。关键结果在689例FIT异常的患者中，45%（n = 314）未完成随访结肠镜检查。在314名未完成者中，184名患者报告了未完成随访结肠镜检查的原因，包括健康保险相关挑战（38%），共病（37%），社会障碍，如交通困难和缺乏社会支持（29%），对FIT/结肠镜检查过程的担忧（12%），竞争性生活优先事项（12%），肠道准备的不良影响（3%）和健康素养差（3%）。在314名未完成者中，131名患者没有报告屏障，因为51%的患者报告在过去10年中完成了既往结肠镜检查，10%的患者没有理由拒绝，10%的患者从未通过电话联系过。结论未来的研究旨在提高FIT筛查和随后的结肠镜检查率，需要解决患者对有效和可持续筛查计划的独特需求。
Background For colorectal cancer (CRC) screening to improve survival, patients with an abnormal fecal immunochemical test (FIT) must follow-up with a diagnostic colonoscopy. Adherence to follow-up is low and patient-level barriers for suboptimal adherence have yet to be explored. Objective To characterize barriers for non-completion of diagnostic colonoscopy after an abnormal FIT reported by under- and uninsured patients receiving care in a safety-net health system. Design A longitudinal, cohort study of CRC screening outreach to 8565 patients using mailed FIT kits. Patients with abnormal FIT results received telephonic navigation to arrange for a no-cost diagnostic colonoscopy. Patients Adults aged 50-64 years receiving care at a North Texas safety-net health system. Approach Descriptive analyses characterized the patient sample and reasons for lack of follow-up after abnormal FIT over the 3-year outreach program. Thematic qualitative analyses characterized reasons for lack of follow-up with a colonoscopy after the abnormal FIT. Key Results Of 689 patients with an abnormal FIT, 45% (n = 314) did not complete a follow-up colonoscopy. Among the 314 non-completers, 184 patients reported reasons for not completing a follow-up colonoscopy included health insurance-related challenges (38%), comorbid conditions (37%), social barriers such as transportation difficulties and lack of social support (29%), concerns about FIT/colonoscopy process (12%), competing life priorities (12%), adverse effects of bowel preparation (3%), and poor health literacy (3%). Among the 314 non-completers, 131 patients did not report a barrier, as 51% reported that that had completed a previous colonoscopy in the past 10 years, 10% refused with no reason, and 10% were never reached by phone. Conclusions Future studies aimed at improving FIT screening and subsequent colonoscopy rates need to address the unique needs of patients for effective and sustainable screening programs.