title: Patient participation in colon cancer screening programs.
abstract: BACKGROUND
  The objectives of this study were to survey compliance and identify factors that influence continued participation with periodic colon cancer screening guidelines once patients are seen for their first screening.
  
  
  METHODS
  The study group consisted of 95 patients who had initial fecal occult blood tests (FOBT) and flexible sigmoidoscopy (FS) in 1991 as part of a gastroenterologist-directed, aggressively managed colon cancer screening registry. Regular notices are sent to patients and their primary care provider for annual FOBT and FS at 3- to 5-year intervals.
  
  
  RESULTS
  Of 70 (74%) reviewed, 2 had died and 3 were having colonoscopic surveillance. Thirty-two of the 65 (49%) contacted eligible study subjects were no longer participating. Reasons stated were as follows: unaware that screening was due (14), too busy (6), unpleasant experience (3), and change to insurance provider that did not cover screening (9 [commercial-3, managed care-1, Medicare-5]).
  
  
  CONCLUSIONS
  Despite aggressive program management, 44% of nonparticipators reported that they were unaware that screening was due. Sixteen percent of those who did not continue to participate had graduated to Medicare, which did not cover screening costs. Factors that influence continued participation need to be considered in the design of public education and marketing promotions.
authors.affiliation: Department of Health, Physical Education and Leisure, University of South Alabama, Mobile, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: DiPalma
authors.forename: S E
authors.initials: SE
authors.lastname: Barnes
authors.forename: J A
authors.initials: JA
authors.lastname: DiPalma
mesh_terms: D001294:Attitude to Health; D003110:Colonic Neoplasms / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data*; D008875:Middle Aged; D009780:Occult Blood; D012042:Registries; D012812:Sigmoidoscopy