Hispanic Patients Reported Factors for Colonoscopy "No-Shows" Despite a Culturally Tailored Patient Navigation Program.

BACKGROUND

Multiple studies have been conducted to understand patient-specific barriers to adequate colorectal cancer screening; however, few have offered in-depth reflections directly from patients who have "no-show" to their colonoscopy appointments. This observational study was designed to identify reasons for missed or canceled colonoscopy appointments among Hispanic patients enrolled in our culturally tailored patient navigation program (CTPNP).

METHODS

Hispanic patients scheduled for a colonoscopy in the CTPNP at Roger Williams Medical Center in Providence, RI, from 2016 to 2019 were followed. Patients who missed or canceled their colonoscopy appointments underwent semi-structured interviews to identify the reason for the no-show or cancellation.

RESULTS

Out of the 698 Hispanic patients enrolled in the CTPNP, 85% completed colonoscopy; however, 15% (n = 104) canceled or missed their colonoscopy. The most common reasons for cancellation were financial constraints at 24% (n = 25), transportation at 11.6% (n = 12), family health problems at 7.8% (n = 10), relocation at 8.6% (n = 9), fear of procedure at 8.6% (n = 9) or performed at different facility 6.7% (n = 7). 18% of patients who missed colonoscopy appointments (n = 19) could not be contacted.

CONCLUSION

Financial constraints are the most common reported reason for missed colonoscopy in Hispanic patients.

POLICY IMPLICATIONS

Financial barriers remain the most critical barrier to colonoscopy. Copays and charges for a diagnostic colonoscopy instead of a screening colonoscopy were also reported as barriers. Since this work, a bill has passed in RI to address this gap in coverage, requiring insurance companies to cover costs for all colorectal screening, whether classified as screening or diagnostic.