title: Patient factors associated with non-attendance at colonoscopy after a positive screening faecal occult blood test.
abstract: Background Screening participants with abnormal faecal occult blood test results who do not attend further testing are at high risk of colorectal cancer, yet little is known about their reasons for non-attendance. Methods We conducted a medical record review of 170 patients from two English Bowel Cancer Screening Programme centres who had abnormal guaiac faecal occult blood test screening tests between November 2011 and April 2013 but did not undergo colonoscopy. Using information from patient records, we coded and categorized reasons for non-attendance. Results Of the 170 patients, 82 were eligible for review, of whom 66 had at least one recorded reason for lack of colonoscopy follow-up. Reasons fell into seven main categories: (i) other commitments, (ii) unwillingness to have the test, (iii) a feeling that the faecal occult blood test result was a false positive, (iv) another health issue taking priority, (v) failing to complete bowel preparation, (vi) practical barriers (e.g. lack of transport), and (vii) having had or planning colonoscopy elsewhere. The most common single reasons were unwillingness to have a colonoscopy and being away. Conclusions We identify a range of apparent reasons for colonoscopy non-attendance after a positive faecal occult blood test screening. Education regarding the interpretation of guaiac faecal occult blood test findings, offer of alternative confirmatory test options, and flexibility in the timing or location of subsequent testing might decrease non-attendance of diagnostic testing following positive faecal occult blood test.
authors.affiliation: 1 Centre for Medical Imaging, University College London, London, UK.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Plumb
authors.affiliation: 2 Health Behaviour Research Centre, University College London, London, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Ghanouni
authors.affiliation: 3 London Hub, Bowel Cancer Screening Programme, Northwick Park Hospital, Harrow, UK.
authors.forename: Sandra
authors.initials: S
authors.lastname: Rainbow
authors.affiliation: 3 London Hub, Bowel Cancer Screening Programme, Northwick Park Hospital, Harrow, UK.
authors.forename: Natasha
authors.initials: N
authors.lastname: Djedovic
authors.affiliation: 4 St Marks Screening Centre, St Marks Hospital, Harrow, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Marshall
authors.affiliation: 5 University College Screening Centre, University College London Hospitals, London, UK.
authors.forename: Judith
authors.initials: J
authors.lastname: Stein
authors.affiliation: 1 Centre for Medical Imaging, University College London, London, UK.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Taylor
authors.affiliation: 1 Centre for Medical Imaging, University College London, London, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Halligan
authors.affiliation: 2 Health Behaviour Research Centre, University College London, London, UK.
authors.forename: Georgios
authors.initials: G
authors.lastname: Lyratzopoulos
authors.affiliation: 2 Health Behaviour Research Centre, University College London, London, UK.
authors.forename: Christian
authors.initials: C
authors.lastname: von Wagner
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000379:methods / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D009780:Occult Blood; D010349:Patient Compliance; D017010:Reminder Systems; D012189:Retrospective Studies; D013222:State Medicine
keywords: Colorectal cancer screening; case-note review; colonoscopy; non-attendance