Compliance, attitudes and barriers to post-operative colorectal cancer follow-up.
BACKGROUND
Meta-analyses demonstrate that surveillance following curative-intent colorectal cancer (CRC) surgery can improve survival. Our multidisciplinary team adopted a stringent CRC follow-up (FU) guideline in 2000. The purpose of this study was to assess adherence and barriers to FU for CRC.


METHODS
Patients with primary CRC aged 19-75 years, treated with curative intent surgery from July 2000 to December 2002 were identified from a prospective database. Compliance with FU was assessed primarily by chart review. We also surveyed patients and providers to explore attitudes and barriers to surveillance adherence using tenets of the Health Belief Model.


RESULTS
96 patients met inclusion criteria and were appropriate for FU. Median FU was 34 months. Guideline targets were met for 70% of clinic visits; 49% of carcinoembryonic antigen (CEA) determinations; and 62% of abdominal imaging studies. Post-operative colonoscopy did not occur in 6/93 patients. Seventy per cent of health care providers and 55% of patients completed a survey. Access to testing and confusion about which provider orders investigations were identified as important barriers to FU.


CONCLUSIONS
Patterns of CRC FU were widely variable despite implementation of a guideline. Despite patient and provider agreement with the principles of CRC FU, adoption was inhibited by confusion among multiple providers regarding investigation coordination.
Cardella
Jonathan
J
Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Coburn
Natalie G
NG
Gagliardi
Anna
A
Maier
Barbara-Anne
BA
Greco
Elisa
E
Last
Linda
L
Smith
Andrew J
AJ
Law
Calvin
C
Wright
Frances
F
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002170:Canada; D015179:Colorectal Neoplasms / Q000601:surgery*; D003266:Continuity of Patient Care; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010349:Patient Compliance; D011182:Postoperative Care; D012189:Retrospective Studies