Abstract C125: Identifying barriers to follow-up colonoscopy completion after an abnormal fecal test: Interviews with gastroenterology staff
Authors: Rivelli Jennifer S , Schneider Jennifer L , Thompson Jamie H , Petrik Amanda F , Torres DeeDee , Coronado Gloria D 
Published: September 2020

Background Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Fecal immunochemical tests (FITs) are an accepted way to identify patients at risk for CRC. However, patients who receive an abnormal FIT result must obtain a follow-up colonoscopy. Rates of follow-up colonoscopy are low in most healthcare settings, particularly in federally qualified health centers (FQHCs). FQHC patients who need a follow-up colonoscopy must undergo several steps, including obtaining a referral to a gastroenterology specialist (GIs), and preparing for and attending the procedure. Interventions such as patient navigation may improve follow-up colonoscopy adherence for FQHC patients, yet little is known about the system-level barriers to the colonoscopy process. Methods As part of the Predicting and Addressing Colonoscopy Non-adherence in Community Settings (PRECISE) study, we interviewed care coordinators and GIs who receive referrals from local FQHCs for follow-up colonoscopies from abnormal FIT tests. Our goal was to understand their referral processes and what they perceive to be the primary barriers for patients completing the follow-up colonoscopy. Two trained qualitative staff conducted the interviews by telephone, and content analyzed the data from interview notes and transcribed recordings. Results We interviewed 12 GI and care coordinator staff across 7 different GI practices. Six of the seven GI practices attempted to facilitate the follow-up colonoscopy by not making a pre-procedure visit mandatory but rather allowing completion by telephone, if the patient is healthy and of low risk. Most GI practices identified using the same type of bowel preparation with community referred patients as it is inexpensive, covered by most insurance plans, and considered safe. The greatest barrier to colonoscopy completion by referred community patients stated by all GI practices was not having transportation to and from the appointment or understanding the need for an escort to be present, particularly at the completion of the colonoscopy. Lack of understanding the bowel preparation process was also a very common barrier, including when to start the process, what foods to avoid, and the need to consume the entire preparation. Faxed referrals from FQHCs lacking proper documentation of the abnormal FIT or incomplete patient medical information for the referral was also cited as hindrances to timely follow-up colonoscopy completion. Most GI practices reported limited resources and time for helping patients address structural challenges pertaining to transportation, escorts, or a private place to complete the preparation. Conclusion Our findings identify key areas where patient navigated efforts are needed, and inform the educational and structural challenges facing FQHC patients when interfacing with GI specialists for a follow-up colonoscopy. These findings can further inform the design and implementation of patient navigation programs in the community health center setting.

Citation Format: Jennifer S Rivelli, Jennifer L Schneider, Jamie H Thompson, Amanda F Petrik, DeeDee Torres, Gloria D Coronado. Identifying barriers to follow-up colonoscopy completion after an abnormal fecal test: Interviews with gastroenterology staff [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C125.