title: Factors that affect adherence to surveillance colonoscopy in patients with inflammatory bowel disease.
abstract: BACKGROUND
  Patients with extensive ulcerative colitis or Crohn's disease of the colon have an increased risk of colon cancer and require colonoscopic surveillance. This study explores factors that affect adherence to surveillance colonoscopy.
  
  
  METHODS
  Three hundred and seventy-eight patients with ulcerative colitis or Crohn's disease of the colon for at least 7 years and at least one-third of the colon involved participated in this cross-sectional questionnaire study performed at 3 tertiary referral inflammatory bowel disease clinics.
  
  
  RESULTS
  Two hundred and eight patients were female and 189 had ulcerative colitis. The mean age was 49.9 years and mean disease duration 22.9 years. The total number of surveillance colonoscopies performed was 1529, and the mean number per patient was 4.01. The mean interval between surveillance colonoscopies was 2.71 years; 282 patients had a mean interval of <3 years. Self-reported adherence was consistently higher than chart-documented adherence. Significant categories of reasons for nonadherence were logistics (P = 0.012), health perceptions (P = 0.0001); stress regarding procedure, job, or personal life (P = 0.0002); and procedure problems (P = 0.001). The most frequently cited most important reason was difficulty with the bowel preparation (18 patients; 4.8%). Of the 26 patients with inflammatory bowel disease-related dysplasia, 3 had cancer, 4 high-grade dysplasia, 15 low-grade dysplasia, and 4 indefinite dysplasia. Detection of dysplasia was not related to adherence or to lack of adherence.
  
  
  CONCLUSIONS
  In this study, 25.5% of our patients underwent surveillance colonoscopies at >3-year intervals on average. Significant categories of reasons for nonadherence included logistics, health perceptions, stress, and procedure problems.
authors: Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. edman1@partners.org
authors: Sonia
authors: S
authors: Friedman
authors: Adam S
authors: AS
authors: Cheifetz
authors: Francis A
authors: FA
authors: Farraye
authors: Peter A
authors: PA
authors: Banks
authors: Frederick L
authors: FL
authors: Makrauer
authors: Robert
authors: R
authors: Burakoff
authors: Barbara
authors: B
authors: Farmer
authors: Leanne N
authors: LN
authors: Torgersen
authors: Kelly E
authors: KE
authors: Wahl
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003093:Colitis, Ulcerative / Q000150:complications / Q000523:psychology*; D003113:Colonoscopy / Q000523:psychology*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D003424:Crohn Disease / Q000150:complications / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010349:Patient Compliance / Q000523:psychology*; D057566:Self Report; D011795:Surveys and Questionnaires