Patients’ experiences and reported barriers to screening colonoscopy: A systematic review

Abstract

1537 Background: Colonoscopy is a component of most colorectal screening programs, as a primary test or as follow-up to an abnormal FOB test. Little is known about why some patients do not comply with colonoscopy after being referred. Methods: A search strategy using three themes of screening, colonoscopy, and patient acceptance was developed and used in MEDLINE, EMBASE and PSYCHinfo (1996–2008). Retrieved citations were assessed for eligibility by two reviewers using prespecified criteria. A qualitative synthesis was conducted. Results: From an initial 3,174 studies, 264 were identified as potentially eligible for review. After full text assessment, 64 studies met eligibility criteria and were included in the final analysis. Six studies examined the experience of a primary colonoscopy by eliciting patients’ views soon after they had the test. Fifty-six studies addressed patient-reported concerns and barriers to an anticipated primary colonoscopy. Most patients perceived the laxative bowel preparation to be the most burdensome part and the greatest barrier to colonoscopy. Other reported difficulties included anxiety and anticipation of pain. Feelings of embarrassment and vulnerability occurred, particularly in women, and also acted as barriers to adherence. Inadequate knowledge about screening was common and was identified as an obstacle to the uptake of screening colonoscopy as was fear of finding cancer. Physician endorsement, having a family history, knowing someone with cancer, and perceived accuracy of the test were incentives to having a colonoscopy. The most common reported practical barriers were inconvenience, transportation, scheduling, and cost. Only two studies focused on colonoscopy as a secondary procedure in the screening context. Similar procedural, personal, and practical concerns were reported by patients in this setting. Conclusions: Bowel preparation, lack of awareness of the importance of screening, and feelings of vulnerability in women are all significant barriers to colonoscopy in the screening context. These obstacles need to be addressed, and further research undertaken on barriers to second line colonoscopy. No significant financial relationships to disclose.