title: Racial/Ethnic Minorities Ineligible for Direct Access Colonoscopy (DAC): Identifying Patients Who Fall Through the Cracks.
abstract: OBJECTIVE
  Patients ineligible for direct access colonoscopy (DAC) are typically referred for a pre-colonoscopy consultation with gastroenterology (GI). However, the referral from primary care to GI creates the potential for patients to drop out of treatment. The primary objective of the current study was to examine the proportion of participants deemed ineligible for DAC that (1) attended an appointment with GI and (2) completed a screening colonoscopy. The second aim of the study was to examine predictors of screening colonoscopy adherence.
  
  
  METHODS
  Participants (N = 144) were average-risk patients who received a primary care referral for a screening colonoscopy and were deemed ineligible for DAC between 2008 and 2012. Following the primary care visit, participants completed a questionnaire that assessed demographics and psychological factors. Medical chart review determined whether participants completed the screening colonoscopy via the GI referral.
  
  
  RESULTS
  Of the 144 participants, only 19 (13 %) completed the screening colonoscopy via the GI referral. Multiple regression analyses revealed that decisional balance was the only unique predictor of screening colonoscopy adherence.
  
  
  CONCLUSIONS
  Patients deemed ineligible for DAC are highly unlikely to complete a screening colonoscopy. Interventions are needed to increase screening colonoscopy adherence in this vulnerable population.
authors: Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1130, New York, NY, 10029-6574, USA. Sarah.Miller@mssm.edu.
authors: Sarah J
authors: SJ
authors: Miller
authors: Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1130, New York, NY, 10029-6574, USA. Jamilia.Sly@mssm.edu.
authors: Jamilia R
authors: JR
authors: Sly
authors: Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1130, New York, NY, 10029-6574, USA. steven.itzkowitz@mountsinai.org.
authors: Steven H
authors: SH
authors: Itzkowitz
authors: Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1130, New York, NY, 10029-6574, USA. Lina.Jandorf@mssm.edu.
authors: Lina
authors: L
authors: Jandorf
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000208:ethnology / Q000517:prevention & control; D004608:Eligibility Determination / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005762:Gastroenterology / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000208:ethnology; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000208:ethnology / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data
keywords: Colonoscopy; Direct access colonoscopy; Disparities; Minority health