QS104 - Reasons for Failure to Complete Colonoscopy in a State Sponsored Colorectal Cancer Screening Program

Sunday, June 2, 2024

8:24 AM – 8:27 AM ET, USA

Location: Room 327

Quick Shot Presenter(s)

Jeremie M.P Lever, MD, PhD (he/him/his)

General Surgery Resident
University of Alabama at Birmingham
University of Alabama at Birmingham
Birmingham, AL, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Author(s)

Hannah Ficarino, MD (she/her/hers)

Resident
University of Alabama at Birmingham
University of Alabama at Birmingham
Birmingham, AL, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
MM

M. Chandler McLeod, PhD, MS

Biostatistician
University of Alabama at Birmingham, Department of Surgery
Birmingham, Alabama, United States

Disclosure information not submitted.
Karin Hardiman, MD, PhD, FACS, FASCRS (she/her/hers)

Associate Professor of Surgery
UAB
University of Alabama at Birmingham
Birmingham, Alabama, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
GK

Gregory D. Kennedy, MD, PhD (he/him/his)

Professor of Surgery
University of Alabama at Birmingham
University of Alabama at Birmingham
Vestavia, Alabama, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
PA

Patricia Ajayi-Fox, MD

Assistant Professor
UAB
Birmingham, Alabama, United States

Disclosure information not submitted.

Senior Author(s)

Robert Hollis, MD MSPH

Assistant Professor
University of Alabama at Birmingham
University of Alabama at Birmingham
Birmingham, AL, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Purpose/Background: State sponsored colorectal cancer screening programs play an important role for reducing the incidence, morbidity, and mortality for colorectal cancer in un- and under-insured patients. However, many barriers to completing colorectal cancer screening exist for these patients. We evaluated colonoscopy completion rates within a state sponsored colorectal cancer screening program and hypothesized that completion failures would primarily be driven by communication challenges.

Methods/Interventions: We performed a retrospective analysis on all patients referred for colonoscopy through a colorectal cancer screening program sponsored by a state public health department in the Deep South between 2022-2023. Eligible patients originated from a single county, had an income level at or below 200% of the federal poverty level, and were either un- or under-insured. Patients qualified for colonoscopy referral if they met criteria for screening or for diagnostic colonoscopy. The primary outcome was defined as completion of a colonoscopy with adequate bowel preparation. Secondary outcomes included reasons for failure to complete colonoscopy such as inability to reach the patient to schedule and no-show after scheduling. Outcomes were compared by demographics, colonoscopy indication, and the time from referral to ordering using bivariate tests.

Results/Outcomes: There were 133 patients referred for colonoscopy and 87 patients (65%) completed endoscopic evaluation. Referred patients had an average age of 58 +/- 5 years; 43% were women, and 74% were Black. There was not difference in age, sex or race by colonoscopy completion status (P>0.05). The indication for colonoscopy in referrals was average risk in 62%, high risk in 11%, and diagnostic in 18%. There was not a difference in indication by completion status (P = 0.06). Among patients that did not complete the colonoscopy, reasons for lack of completion included patient cancellation after scheduling (33%; n=15), inability to contact to schedule (29%; n=13), scheduled but no-show (24%; n=11), and poor bowel preparation (11%; n=5, Figure 1). Only one patient did not complete due to medical reasons. There was no difference in time between referral and order placement for patients who completed versus did not complete (days: 4 +/- 4 vs. 3 +/- 3; P>0.05).

Conclusion/Discussion: Colonoscopy completion rates in a state-sponsored colorectal cancer screening program were suboptimal. Communication (ability to contact patients) and coordination of care (scheduling, need to reschedule, no-show rates) were major contributors to failure of completion of colonoscopy. These findings highlight that covering only the financial costs of colonoscopy in a state sponsored program is insufficient to achieve successful colonoscopy screening rates in vulnerable populations.