Barriers and facilitators to colonoscopy following fecal immunochemical test screening for colorectal cancer: A key informant interview study

Robert S Kerrison,Elizabeth Travis,Christina Dobson,Katriina L Whitaker,Colin J Rees,Stephen W Duffy,Christian Von Wagner

doi:10.1016/j.pec.2021.09.022

Abstract

ObjectivesPeople who are referred for colonoscopy, following an abnormal colorectal cancer (CRC) screening result, are at increased risk of CRC. Despite this, many individuals decline the procedure. The aim of this study was to investigate why. MethodsAs little is currently known about non-attendance at follow-up colonoscopy, and follow-up of abnormal screening results is a nurse-led process, we decided to conduct key informant interviews with Specialist Screening Practitioners ([SSPs] nurses working in the English Bowel Cancer Screening Program). Interviews were conducted online. Transcripts were assessed using inductive and deductive coding techniques. Results21 SSPs participated in an interview. Five main types of barriers and facilitators to colonoscopy were described, namely: Sociocultural, Practical, Psychological, Health-related and COVID-related. Key psychological and sociocultural factors included: ‘Fear of pain and discomfort associated with the procedure’ and ‘Lack of support from family and friends’. Key practical, health-related and COVID-related factors included: ‘Family and work commitments’, ‘Existing health conditions as competing priorities’ and ‘Fear of getting COVID-19 at the hospital'. ConclusionsA range of barriers and facilitators to follow-up colonoscopy exist. Future studies conducted with patients are needed to further explore barriers to colonoscopy. Practice implicationsStrategies to reduce non-attendance should adopt a multifaceted approach.

Highlights

Colorectal cancer (CRC, referred to as ‘bowel cancer’) is a leading cause of morbidity and mortality in Europe [1]
In a recent interna tional survey of 35 fecal immunochemical test (FIT) screening programs, Selby et al found that the mean proportion of participants with a positive FIT result who complete follow-up colonoscopy was only 79%, with completion rates ranging from 39% in the program with the lowest level of follow-up, to 100% in the country with the highest [4]
Barriers and facilitators to colonoscopy following fecal immunochemical test screening for colorectal cancer: A key informant interview study, Patient Education and Counseling, https://doi.org/10.1016/ j.pec.2021.09.022i adverse outcomes, including increased risk of CRC, advanced stage diagnosis and CRC death [5]

Summary

Introduction

Colorectal cancer (CRC, referred to as ‘bowel cancer’) is a leading cause of morbidity and mortality in Europe [1]. Several large randomized controlled trials (RCTs) have shown that regular fecal immunochemical test (FIT) screening, between the ages of 45 and 80, can significantly reduce the mortality of the disease among people who complete the test [2]. Barriers and facilitators to colonoscopy following fecal immunochemical test screening for colorectal cancer: A key informant interview study, Patient Education and Counseling, https://doi.org/10.1016/ j.pec.2021.09.022i adverse outcomes, including increased risk of CRC, advanced stage diagnosis and CRC death [5]. There is much current in terest in understanding the reasons for lack of follow-up, and how to prevent it [6,7]

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Discussion

Conclusion