Prospective Cohort study of Predictors of Follow-Up Diagnostic Colonoscopy from a Pragmatic Trial of FIT Screening

Elizabeth A O'Connor,Carrie M Nielson,Amanda F Petrik,Gloria D Coronado,Beverly B Green

doi:10.1038/s41598-020-59032-0

Abstract

The goal of this study was to explore diagnostic colonoscopy completion in adults with abnormal screening fecal immunochemical test (FIT) results. This was a secondary analysis of the Strategies and Opportunities to Stop Colon Cancer in Priority Populations (Stop CRC) study, a cluster-randomized pragmatic trial to increase uptake of CRC screening in federally qualified community health clinics. Diagnostic colonoscopy completion and reasons for non-completion were ascertained through a manual review of electronic health records, and completion was compared across a wide range of individual patient health and sociodemographic characteristics. Among 2,018 adults with an abnormal FIT result, 1066 (52.8%) completed a follow-up colonoscopy within 12 months. Completion was generally similar across a wide range of participant subpopulations; however, completion was higher for participants who were younger, Hispanic, Spanish-speaking, and had zero or one of the Charlson medical comorbidities, compared to their counterparts. Neighborhood-level predictors were not associated with diagnostic colonoscopy completion. Thus, completion of a diagnostic colonoscopy was relatively low in a large sample of community health clinic adults who had an abnormal screening FIT result. While completion was generally similar across a wide range of characteristics, younger, healthier, Hispanic participants tended to have a higher likelihood of completion.

Highlights

Colorectal cancer (CRC) incidence and mortality have declined markedly among Americans ages 50 and older since 1990, a victory partially attributable to improved screening rates[1]
This follow-up makes it possible to reduce the risk of colorectal cancer and prevent more advanced-stage disease; low follow-up colonoscopy completion substantially reduces the effectiveness of fecal immunochemical testing (FIT) screening[10,11]
Reasons for noncompletion were found in the electronic health record (EHR) of 546 of the 952 participants who did not complete a follow-up colonoscopy (Table 2)

Summary

Introduction

Colorectal cancer (CRC) incidence and mortality have declined markedly among Americans ages 50 and older since 1990, a victory partially attributable to improved screening rates[1]. An essential corollary to FIT uptake is the delivery of timely follow-up diagnostic colonoscopy for individuals with a positive FIT result This follow-up makes it possible to reduce the risk of colorectal cancer and prevent more advanced-stage disease; low follow-up colonoscopy completion substantially reduces the effectiveness of FIT screening[10,11]. The proportion completing a follow-up colonoscopy after a FIT-positive result has been reported to be approximately 30% to 60% in safety-net and Veterans Affairs health care systems[12,13,14,15,16], rising to ~80% in integrated health care organizations[17,18]. Patients and clinicians in low-resource clinical settings who comply with FIT screening face additional www.nature.com/scientificreports barriers to completing a timely follow-up diagnostic colonoscopy essential for cancer prevention. Given the importance of follow-up colonoscopy in realizing the benefits of improved FIT screening, we investigated individual and neighborhood factors associated with timely follow-up colonoscopy completion

Objectives

Methods

Results

Discussion

Conclusion