Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
BMC Gastroenterol. 2020 Apr 19;20(1):115. doi: 10.1186/s12876-020-01262-7.
The fecal immunochemical test (FIT) is the second most commonly used colorectal cancer (CRC) screening modality in the United States; yet, follow-up of abnormal FIT results with diagnostic colonoscopy is underutilized. Our objective was to determine patient-reported barriers to diagnostic colonoscopy following abnormal FIT in an academic healthcare setting.
We included patients age 50-75 with an abnormal FIT result between 1/1/2015 and 10/31/2017 and no documented follow-up diagnostic colonoscopy. We abstracted demographic data from the electronic health record (EHR). Study personnel conducted telephone surveys with patients to confirm colonoscopy completion and elicit data on notification of FIT results and barriers to colonoscopy. We also provided brief verbal education about diagnostic colonoscopy. We calculated frequencies of demographic data and survey responses and compared survey responses by interest in colonoscopy after education.
We surveyed 67 patients. Fifty-one were aware of the abnormal FIT result, and a majority learned of the abnormal FIT result by direct communication with providers (19, 37.3%) or EHR messaging (11, 21.6%). Overall, fifty-three patients (79.1%) confirmed lack of colonoscopy, citing provider-related (19, 35.8%), patient-related (16, 30.2%), system-related (1, 1.9%), or multifactorial (17, 32.1%) reasons. Lack of knowledge of FIT result (14, 26.4%) was most common. After brief education, 20 (37.7%) patients requested colonoscopy.
Patients with an abnormal FIT reported various multi-level barriers to diagnostic colonoscopy after abnormal FIT, including knowledge of FIT results. When provided with brief education, participants expressed interest in diagnostic colonoscopy. Future efforts will evaluate interventions to improve colonoscopy follow-up.
粪便免疫化学检测（FIT）是美国第二常用的结直肠癌（CRC）筛查方式；然而，在学术医疗环境中，对异常 FIT 结果进行诊断性结肠镜检查的随访利用不足。我们的目的是确定在学术医疗环境中，对异常 FIT 结果进行诊断性结肠镜检查的患者报告的障碍。
我们纳入了年龄在 50-75 岁之间、在 2015 年 1 月 1 日至 2017 年 10 月 31 日之间出现异常 FIT 结果且无记录的诊断性结肠镜检查随访的患者。我们从电子健康记录（EHR）中提取人口统计学数据。研究人员通过电话调查患者，以确认结肠镜检查的完成情况，并收集关于 FIT 结果通知和结肠镜检查障碍的数据。我们还提供了关于诊断性结肠镜检查的简短口头教育。我们计算了人口统计学数据和调查结果的频率，并比较了教育后对结肠镜检查感兴趣的调查结果。
我们调查了 67 名患者。51 名患者知道异常 FIT 结果，大多数人是通过与提供者的直接沟通（19 名，37.3%）或 EHR 消息（11 名，21.6%）得知异常 FIT 结果的。总体而言，53 名患者（79.1%）确认未进行结肠镜检查，原因包括提供者相关（19 名，35.8%）、患者相关（16 名，30.2%）、系统相关（1 名，1.9%）或多因素（17 名，32.1%）。最常见的是缺乏对 FIT 结果的了解（14 名，26.4%）。经过简短的教育，20 名（37.7%）患者要求进行结肠镜检查。
异常 FIT 患者报告了各种多层次的诊断性结肠镜检查障碍，包括对 FIT 结果的了解。当提供简短的教育时，参与者表示对诊断性结肠镜检查感兴趣。未来的研究将评估改善结肠镜检查随访的干预措施。
