Patients’ experiences and reported barriers to colonoscopy in the screening context—A systematic review of the literature

McLachlan, Sue‐Anne; Clements, Alison; Austoker, Joan

doi:10.1016/j.pec.2011.04.010

Cited by 226 publications

(191 citation statements)

References 62 publications

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“…1 Other studies found that fear of intraprocedural pain and embarrassment were significant barriers to compliance with a colonoscopy examination. 2,3 In contrast, healthcare professionals may prioritize safety, ease of colonoscopy completion, and rapid and complete cognitive recovery to facilitate early discharge. Arguably, both lighter and deeper sedation can potentially achieve these goals.…”

Section: Résumémentioning

confidence: 99%

A randomized controlled trial of light versus deep propofol sedation for elective outpatient colonoscopy: recall, procedural conditions, and recovery

Allen

Leslie

Hebbard

et al. 2015

Can J Anesth/J Can Anesth

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A randomized controlled trial of light versus deep propofol sedation for elective outpatient colonoscopy: recall, procedural conditions, and recovery Une étude randomisée contrôlée sur la sédation légère vs profonde au propofol pour la colonoscopie non urgente en ambulatoire: le souvenir, les conditions entourant l'intervention et la récupération sedation; P \ 0.0001). The incidence of recall was 12% in the light sedation group and 1% in the deep sedation group. The risk difference for recall was 0.11 (90% confidence interval, 0.05 to 0.17) in the intention-to-treat analysis, thus refuting equivalence in recall between light and deep sedation (0.05 significance level; 10% equivalence margin). Overall sedation-related complications were more frequent with deep sedation than with light sedation (66% vs 47%, respectively; P = 0.008). Recovery was more rapid with light sedation than with deep sedation as determined by the mean (SD) time to reach a score of 5 on the Modified Observer's Assessment of Alertness/Sedation Scale [3 (4) min vs 7 (4) min, respectively; P \ 0.001] and by the median [IQR] time to min, respectivement; P = 0.001). L'incidence des troubles cognitifs post-procéduraux était semblable chez les personnes randomisées à recevoir une sédation légère (19 %) ou profonde (16 %) (P = 0,554). Conclusion La sédation légère n'était pas équivalente à la sédation profonde en matière de souvenir de l'intervention, du spectre de complications ou des temps de récupération. Cette étude procure des données probantes nécessaires pour informer les patients concernant la sédation pour la colonoscopie. Cette étude a été enregistrée au Registre australien et néozélandais des études cliniques, no. 12611000320954.

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Section: Résumémentioning

confidence: 99%

A randomized controlled trial of light versus deep propofol sedation for elective outpatient colonoscopy: recall, procedural conditions, and recovery

Allen

Leslie

Hebbard

et al. 2015

Can J Anesth/J Can Anesth

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“…[1][2][3][4] However, its effectiveness for reducing CRC mortality for vulnerable populations is unclear, given the barriers to colonoscopy, including cost, transportation problems, preparing for the procedure, and fear of invasive tests. [5][6][7][8][9][10][11][12] Expanded use of FOBT, a modality with fewer barriers, may be a viable approach to address CRC screening disparities, especially with single-sample fecal immunochemical tests (FIT), which do not require dietary restrictions. 13 Several randomized trials have reported that outreach with FOBT can improve CRC screening rates.…”

Section: Introductionmentioning

confidence: 99%

Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial

et al. 2015

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INTRODUCTION:Colorectal cancer (CRC) screening rates are low among vulnerable populations. Fecal immunochemical tests (FITs) are one screening modality with few barriers. Studies have shown that outreach can improve CRC screening, but little is known about its effectiveness among individuals with no CRC screening history. We sought to determine whether outreach increases FIT uptake among patients with no CRC screening history compared to usual care. METHODS: This study was a patient-level randomized controlled trial, including 420 patients who had never completed CRC screening and were eligible for FIT; 66 % were female, 62.1 % were Latino, and 70.7 % were uninsured. The main outcome measure was FIT completion within 6 months of the randomization date. We assessed FIT completion at different time points corresponding to receipt of outreach components. All analyses were re-run with 12-month data. RESULTS: Patients who received outreach were more likely to complete FIT than those in usual care (36.7 % vs. 14.8 %; p<0.001). FIT completion was more common among patients with increased clinic visits. The difference in FIT completion between the outreach and usual care groups decreased over time. DISCUSSION: The intervention improved FIT uptake among patients with no CRC screening history. However, the intervention was less effective than in a previous trial targeting patients due for repeat screening. Additional research is needed to determine the best methods for improving CRC screening among this hard-to-reach group.KEY WORDS: health disparities; cancer prevention; care delivery system.

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“…FIT/FOBT tests are inexpensive and easy to mail and distribute, and they may result in higher completion rates than screening colonoscopy due to a combination of patient acceptance, cost, logistics, and system capacity factors. 13 However, the effectiveness of a FIT/FOBT strategy depends on whether positive tests are followed up with diagnostic colonoscopy. Given their relationship with patients and repeated contact with them, PCPs may be instrumental in ensuring that patients with positive FIT/FOBT tests complete follow-up colonoscopy.…”

Section: Introductionmentioning

confidence: 99%

Association Between Primary Care Visits and Colorectal Cancer Screening Outcomes in the Era of Population Health Outreach

et al. 2016

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BACKGROUND: Population outreach strategies are increasingly used to improve colorectal cancer (CRC) screening. The influence of primary care on cancer screening in this context is unknown. OBJECTIVE: To assess associations between primary care provider (PCP) visits and receipt of CRC screening and colonoscopy after a positive fecal immunochemical (FIT) or fecal occult blood test (FOBT). DESIGN: Population-based cohort study. PARTICIPANTS: A total of 968,072 patients ages 50-74 years who were not up to date with CRC screening in 2011 in four integrated healthcare systems (three with screening outreach programs using FIT kits) in the PopulationBased Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. MEASURES: Demographic, clinical, PCP visit, and CRC screening data were obtained from electronic health records and administrative databases. We examined associations between PCP visits in 2011 and receipt of FIT/ FOBT, screening colonoscopy, or flexible sigmoidoscopy (CRC screening) in 2012 and follow-up colonoscopy within 3 months of a positive FIT/FOBT in 2012. We used multivariable logistic regression and propensity score models to adjust for confounding. RESULTS: Fifty-eight percent of eligible patients completed a CRC screening test in 2012, most by FIT. Those with a greater number of PCP visits had higher rates of CRC screening at all sites. Patients with ≥1 PCP visit had nearly twice the adjusted-odds of CRC screening (OR = 1.88, 95 % CI: 1.86-1.89). Overall, 79.6 % of patients with a positive FIT/FOBT completed colonoscopy within 3 months. Patients with ≥1 PCP visit had 30 % higher adjusted odds of completing colonoscopy after positive FIT/FOBT (OR = 1.30; 95 % CI: 1.22-1.40). CONCLUSIONS:Patients with a greater number of PCP visits had higher rates of both incident CRC screening and colonoscopy after positive FIT/FOBT, even in health systems with active population health outreach programs. In this era of virtual care and population outreach, primary care visits remain an important mechanism for engaging patients in cancer screening.KEY WORDS: primary care; colorectal cancer screening; population health outreach.

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Patients’ experiences and reported barriers to colonoscopy in the screening context—A systematic review of the literature

Cited by 226 publications

References 62 publications

A randomized controlled trial of light versus deep propofol sedation for elective outpatient colonoscopy: recall, procedural conditions, and recovery

A randomized controlled trial of light versus deep propofol sedation for elective outpatient colonoscopy: recall, procedural conditions, and recovery

Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial

Association Between Primary Care Visits and Colorectal Cancer Screening Outcomes in the Era of Population Health Outreach

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