Colonoscopy Followup After Positive Fecal Occult Blood Test- Understanding Barriers to Adherence
Condition: Colorectal Cancer
MeSH terms: Colorectal Neoplasms
Study type: Observational

Summary: 
      Approximately 40% of members with a positive fecal occult blood result do not continue to
      followup colonoscopy in Meuhedet. The purpose of this study is to identify the structural,
      process, carer and patient related causes of undertreatment and suggest appropriate
      organisational interventions. Using both quantitative and qualitative methods, the
      investigators will identify organisational and personal barriers to completion of followup of
      positive FOBT.
    

Detailed description: 
      Colorectal cancer is the second in incidence and mortality among malignant tumors. Early
      detection of the disease is an effective means of reducing mortality and is possible through
      a fecal occult blood test. In the case of a positive result colonoscopy is required. In
      Israel, about 30% of people with a positive occult blood test do not perform a follow-up
      test.

      The aim of the study is to identify existing barriers to undergoing colonoscopy in a
      normal-risk population and improving adherence through different intervention mechanisms. At
      the end of the study we will describe effective intervention models at three levels: the
      patient, physicians and the organisation to improve early detection of colon cancer.

      Innovation of the Study

        -  It will focus on the normal-risk population groups in Israel with a positive occult
           blood that didn't undergo colonoscopy.

        -  Will identify the barriers in diverse populations

        -  Will review the accessibility of diagnostic facilities forcolon cancer in Israel.

        -  Will propose intervention programs to improve adherence at all levels in the process.

      Study Methods: A prospective study sing both both quantitative and qualitative methods in
      Meuhedet Health Services Target Population: Health system managers, physicians, and patients
      (a representative sample of 200 patients adhere colonoscopy and 600 that didn't adhere). Data
      collection databases from Meuhedet. The study will include questionnaires, focus groups and
      interviews.

      Stages of the study:

        1. Describe the magnitude of the problem

        2. Map the barriers to adherence with colonoscopy recommendations among patients,
           physicians and geographic availability of colonoscopies facilities.

        3. Suggest intervention models for physicians, patients and organisations according to the
           information provided by data collection.

        4. Recommendation to decision makers on the implementation of national policy intervention.

      Data processing: will use SPSS statistical analysis with the types of variables.
    

Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        a representative sample of Meuhedet members who adhered / did not adhere to followup of a
        positive fecal occult blood test using colonoscopy