Why Some People Do Not Show Up for Planned Colorectal Cancer Screening

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The summary below is from the full report titled "Predicting Adherence to Colonoscopy or Flexible Sigmoidoscopy on the Basis of Physician Appointment–Keeping Behavior." It is in the 6 April 2004 issue of Annals of Internal Medicine (volume 140, pages 528-532). The authors are B.J. Turner, M. Weiner, C. Yang, and T. TenHave.

What is the problem and what is known about it so far?

Physicians have not successfully predicted which individuals will resist health care measures, such as cancer screening. Many people who agree to have screening for colorectal cancer do not keep the appointment. In colon cancer screening, known as endoscopy, a flexible tube is inserted to directly inspect the inner lining of the bowel wall. Reasons that some people decide not to have screening range from the need to prepare the bowel to concern that the procedure will be painful. Some people may not realize that early cancer detection results in better outcomes. Those who decide not to keep their cancer screening appointment may also miss more scheduled physician appointments. These patients could be targeted for special measures so that they are more likely to attend screening.

Why did the researchers do this particular study?

To learn whether persons who do not show up for planned endoscopy of the colon and rectum also miss scheduled physician appointments.

Who was studied?

11,803 persons who were scheduled to have a first colorectal screening study. All patients had scheduled 3 or more appointments with a physician in the 2 years before the planned endoscopy.

How was the study done?

The researchers analyzed computerized records of patients referred from 23 primary care centers in the same health care system. Patients were scheduled to have either a study of the rectum and lower colon (sigmoidoscopy) or an examination of the entire colon (colonoscopy). The proportion of scheduled physician appointments that were kept by patients who later did attend their scheduled endoscopy was compared with that of patients who did not come. Patients at all the primary care centers were reminded by telephone about the endoscopy before the appointment. They also were mailed a brochure about how to prepare for endoscopy and about the procedure itself.

What did the researchers find?

Only 62% of patients kept their first appointment for a colon study. About 6 in 10 patients who did not attend agreed to reschedule within 6 months, and nearly two thirds of them did have endoscopy. Of those who kept more than 85% of their scheduled appointments in the previous 2 years, 70% attended endoscopy. In contrast, only about half of those who had missed the most scheduled appointments attended screening endoscopy. The numbers were similar for patients who rescheduled.

What were the limitations of the study?

All information in this study came from 1 health care system. The findings may not apply to patients with fewer than 3 scheduled visits to a physician in a 2-year period.

What are the implications of the study?

When patients are scheduled for colorectal cancer screening, special efforts to encourage attendance might be made for those who have missed many of their physician appointments.

Read all Rapid Responses

Non-adherence to keeping colonoscopy appointments may have a reason!

Edward L Arsura, et al.

Annals Online, 6 May 2004 [Full text]