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Barriers and Facilitators to Timely Colonoscopy Completion for Safety Net Clinic Patients

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Objectives: In this study, we conducted telephone interviews with patients in community clinics who had abnormal fecal immunochemical test (FIT) results to identify follow-up colonoscopy challenges. The FIT is an effective colorectal cancer screening method, but its value is contingent on follow-up diagnostic colonoscopy. Methods: We explored barriers at 3 timepoints: (1) abnormal FIT-result communication, (2) scheduling/completion of colonoscopy, and (3) receipt of results. We sought to understand variation in experience by both Spanish and English language patients. Results: We interviewed 32 patients (16 English; 16 Spanish), 66% of whom were women. There were 13 early completers (≤ 2 months after FIT result), 14 later completers (> 2 months after FIT result), and 5 non-completers of the colonoscopy. The greatest challenge was fear of the procedure, expressed more often by Spanish language (SL) participants and later completers. SL participants also cited cost and lack of clear communication about the need for a colonoscopy. English language (EL) participants experienced lack of reliable transportation. Conclusions: Barriers to timely colonoscopy completion following an abnormal FIT can occur at different transitions in care and vary by patient characteristics. Our findings may inform the design of programs to improve colonoscopy completion in safety net clinics.
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Keywords: COLON CANCER SCREENING; COLONOSCOPY BARRIERS; FECAL IMMUNOCHEMICAL TEST; HEALTH DISPARITIES; QUALITATIVE RESEARCH; SAFETY NET CLINICS

Document Type: Research Article

Affiliations: 1: Jennifer L. Schneider, Senior Research Associate, Center for Health Research, Kaiser Permanente Northwest, Portland, OR;, Email: [email protected] 2: Jennifer S. Rivelli, Research Associate and Manager, Center for Health Research, Kaiser Permanente Northwest, Portland, OR 3: Inga Gruss, Senior Research Associate, Center for Health Research, Kaiser Permanente Northwest, Portland, OR 4: Amanda F. Petrik, Senior Research Associate, Center for Health Research, Kaiser Permanente Northwest, Portland, OR 5: Carrie M. Nielson, Epidemiologist, Center for Health Research, Kaiser Permanente Northwest, Portland, OR 6: Beverly B. Green, Investigator, Kaiser Permanente Washington Health Research Institute, Seattle, WA 7: Gloria D. Coronado, Distinguished Investigator, Center for Health Research, Kaiser Permanente Northwest, Portland, OR

Publication date: July 1, 2020

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  • The American Journal of Health Behavior seeks to improve the quality of life through multidisciplinary health efforts in fostering a better understanding of the multidimensional nature of both individuals and social systems as they relate to health behaviors.

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