Author

Ann Oluloro

Date

5-2015

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health & Preventive Medicine.

Institution

Oregon Health & Science University

Abstract

Background: Colorectal cancer (CRC) is the fourth most common cancer and the fourth leading cause of cancer death in the United States. Fecal testing, including fecal immunochemical testing (FIT), has been proven to reduce mortality from colorectal cancer. Such mortality reductions can only be achieved, however, if those with an abnormal test result receive follow-up colonoscopy. Rates of completion of follow-up colonoscopy are low, especially in community health centers, where many Latinos receive care. As part of the Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) project, we examined rates of adherence to follow-up colonoscopy, time to colonoscopy completion, and characteristics of patients who complete a colonoscopy after an abnormal FIT result compared to those who do not. Methods: Virginia Garcia Memorial Health Center served as a clinic partner for the project. Project staff reviewed charts from patients who had an abnormal FIT result, following the STOP CRC mailed outreach program. Reviews of electronic medical charts ascertained patient demographic characteristics; referral to colonoscopy (yes/no), date of referral and reason (if not made); colonoscopy completion (yes/no), date of colonoscopy and reason (if not completed). Bivariate analyses and regression analyses were used to examine associations and complete mediator analysis. Results: A total of 56 patients had an abnormal FIT result, 29 (52%) were Latino and 31(55%) were female. Forty-five (80%) patients received referral for colonoscopy, with a median time to referral of 2 days. Of the 56 patients, 32(57%) had evidence of a completed colonoscopy in their medical chart. The median time to colonoscopy completion was 62 days. Females were less likely than males to complete their colonoscopy within 60 days of a positive FIT result (OR = 0.23, 95% CI: 0.05, 0.96). Mediation analysis indicated that time to referral was not a mediator between patient-level factors and completion of follow-up colonoscopy. Finally, qualitative results show that there are differences in the CRC screening process between English and Spanish speakers. Conclusion: For fecal testing to reduce mortality from CRC, patients with a positive test result must obtain a follow-up colonoscopy. Our findings suggest improvements are needed to increase rates of follow-up colonoscopy completion, especially among females and Latino patients. Future research might explore the role that clinic-level factors (colonoscopy capacity) and patient-level factors (patient declined) play in colonoscopy completion.

Identifier

doi:10.6083/M4F47MVJ

School

School of Medicine

Included in

Public Health Commons

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