title: Barriers to full colon evaluation for a positive fecal occult blood test.
abstract: BACKGROUND
  Failure to appropriately evaluate a positive cancer screening test may negate the value of doing that test. The primary aim of this study was to explore the factors associated with undergoing a full colon evaluation for a positive fecal occult blood test (FOBT) in a single Veterans Affairs center.
  
  
  METHODS
  Medical records of consecutive patients ages > or = 50 years, who had a positive screening FOBT from March 2000 to February 2001, were abstracted. Patient demographics, dates of ordering and doing follow-up test(s), and adherence with scheduled procedures were collected. The primary outcome, full colon evaluation, was defined as having a colonoscopy or double-contrast barium enema plus flexible sigmoidoscopy completed within 12 months.
  
  
  RESULTS
  The sample (N = 538) was 98% men (58% Caucasian, 29% African-American, and 13% unknown race). Approximately 77% of the patients were referred to gastroenterology. Ultimately, only 44% underwent full colon evaluation within 12 months. Approximately 20% of the patients failed to attend a scheduled procedure. Referral to gastroenterology and adherence to follow-up appointments were associated with full colon evaluation. There was no association between African-American versus Caucasian race and full colon evaluation.
  
  
  CONCLUSIONS
  Less than half of the patients with a positive FOBT had a full colon evaluation within 12 months. Multiple failures were identified, including lack of referral for further testing and patient nonadherence. Although the overall performance in evaluating a positive colorectal cancer screening test was poor, no racial disparity was observed.
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC 27705, USA. deborah.fisher@duke.edu
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Fisher
authors.forename: Amy
authors.initials: A
authors.lastname: Jeffreys
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Coffman
authors.forename: Kenneth
authors.initials: K
authors.lastname: Fasanella
mesh_terms: D001741:Black or African American; D000368:Aged; D001291:Attitude of Health Personnel; D001466:Barium Sulfate; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000208:ethnology; D004733:Enema; D005243:Feces / Q000737:chemistry*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening; D008499:Medical Records; D008875:Middle Aged; D009780:Occult Blood; D012189:Retrospective Studies; D012812:Sigmoidoscopy; D014728:Veterans; D044465:White People
chemical_list: D001466:Barium Sulfate