Non-adherence to diagnostic colonoscopy after positive faecal screening test.

INTRODUCTION

The Danish Colorectal Cancer Screening Programme has achieved a high adherence, in the 88-90% range, to diagnostic colonoscopy following a positive immunochemical faecal occult blood test (iFOBT). However, a small subgroup does not proceed to colonoscopy. This study investigated factors associated with non-adherence to diagnostic colonoscopy in the North Denmark Region (NDR).

METHODS

In 2020, 278 had a positive iFOBT in the NDR and did not undergo subsequent colonoscopy. We conducted a two-part study consisting of 1) a journal audit assessing comorbidity, inflammatory bowel disease (IBD), hospitalisations and colonoscopy history, and 2) a questionnaire exploring self-reported reasons for non-adherence. Among 256 eligible individuals, 169 (66%) completed the questionnaire.

RESULTS

The journal audit revealed that 25% of non-adherent individuals had an ASA score ≥ 3, 65% had a Charlson Comorbidity Index score ≥ 2 and 10% had known IBD. Furthermore, 20% had undergone a colonoscopy within the preceding two years. Questionnaire responses identified recent colonoscopy (n = 29) and haemorrhoids (n = 30) as frequent reasons for non-adherence. Many respondents reported non-medical reasons, including perceiving themselves as healthy, lacking understanding of the programme or finding colonoscopy unpleasant.

CONCLUSIONS

Non-adherence to diagnostic colonoscopy after positive iFOBT is often not medically justified. The findings indicate a need for improved patient education. Enhanced general practitioner involvement may help address logistical and informational barriers.

FUNDING: None.

TRIAL REGISTRATION: Not relevant.