ASPO Abstracts
Abnormal Fecal Test Follow-up for Colorectal Cancer Screening in Federally Qualified Health Centers
Category: Cancer Health Disparities
Conference Year: 2023
Abstract Body:
Purpose: For colorectal cancer (CRC) screening to improve survival, patients with an abnormal fecal immunochemical test (FIT) must follow-up with a diagnostic colonoscopy. Lack of and delayed diagnostic colonoscopies lead to higher risk of death. In partnership with three San Diego area community health centers (CHCs) we conducted a study to better understand the process of abnormal fecal test follow-up for CRC screening from referral to colonoscopy completion. Methods: Our mixed-method study included an electronic health record (EHR) abstraction and focus groups with key clinic personnel. EHR data were extracted from CHC databases for FIT patients 50-75 years old between Jan. to Dec. 2021, with a 6-month follow-up period. Focus group discussions based on data findings were conducted with key clinic personnel (e.g., CHC executive team, referral managers, providers) at each CHC to identify contextual factors for abnormal fecal test follow-up. We synthesized findings to identify best practices and barriers for patient referral and colonoscopy completion. Results: Of the 790 patients who received an abnormal FIT result, 89% were referred to gastroenterology and 26% completed a colonoscopy within 6 months. Among patients with an abnormal FIT result, 2% completed a colonoscopy within 30 days, 9.7% completed within 60 days, 16.4% completed within 90 days, 21.5% completed within 120 days, 24.2% completed within 150 days and 25.8% completed a colonoscopy within 180 days. From focus groups, we learned that colonoscopy completion improved through enhanced case management using patient navigation. Barriers to referral included clinically inappropriate repeat FIT testing, involuntary loss of insurance or becoming uninsured, and absence of standing colonoscopy orders. Perceived barriers to colonoscopy included fear and lack of education about the procedure, transportation issues to appointments, long wait time for specialist appointments, and competing life priorities. Conclusion: Results revealed suboptimal referral and colonoscopy completion rates. Using clinic champions or navigators may address many of these barriers and improve follow-up rates. Even with these strategies in place, innovations are needed to optimize colonoscopy completion after abnormal FIT.
Keywords: colorectal cancer, abnormal fecal test follow-up, community health centers