Homepage > Research abstracts > Early Detection of Colorectal Cancer – Identification of system and personal barriers to adherence with follow-up guidelines after a positive fecal occult blood test
Early Detection of Colorectal Cancer – Identification of system and personal barriers to adherence with follow-up guidelines after a positive fecal occult blood test
Researchers: Revital Azulay1, Anthony Heyman1, Liora Valinsky1, Einat Elran2, Revital Kariv2, Natan Lederman1
- Meuhedet Health Fund
- Maccabi Health Services
Background: It is known that 30% of people with a positive finding of occult blood in Israel do not perform any further investigation.
Objectives: The objectives of the research are to identify barriers to adherence to colonoscopy at the level of the individual, physician, system, organization and policymakers.
Method: The study was conducted at the Meuhedet and Maccabi and included mixed methods – a combination of qualitative and quantitative research, database analyses, focus groups, interviews and questionnaires for the various target populations.
Retrospective study: 2010-2014 Examining barriers according to demographic variables, distance from the gastroenterology clinic (GIS) and availability.
Telephone survey: Patient activity questionnaire (PAM) and health behavior.
2015 - Focus groups and in-depth interviews: family physicians, gastroenterologists and opinion leaders.
Retrospective study: 2010-2014 Examining barriers according to demographic variables, distance from the gastroenterology clinic (GIS) and availability.
Telephone survey: Patient activity questionnaire (PAM) and health behavior.
2015 - Focus groups and in-depth interviews: family physicians, gastroenterologists and opinion leaders.
Findings: 1. Retrospective study: The younger age group 55-60 adhere more to colonoscopy. The higher the SES the higher the rate of performance. The rate of colonoscopy is 40% lower in the Arab population.
2. Telephone survey: Adherence to follow-up is clearly related to purchase of supplementary / private insurance and is not related to PAM. In addition, adherence to follow-up is connected to understanding the FOBT test and its results.
3. Focus groups and interviews: Family physicians underestimate the rates of non-adherence after a positive FOBT. Gastroenterologists do not consider FOBT an efficient test for CRC. The patient is also responsible for their health. There are gaps between populations in the process of further investigation.
2. Telephone survey: Adherence to follow-up is clearly related to purchase of supplementary / private insurance and is not related to PAM. In addition, adherence to follow-up is connected to understanding the FOBT test and its results.
3. Focus groups and interviews: Family physicians underestimate the rates of non-adherence after a positive FOBT. Gastroenterologists do not consider FOBT an efficient test for CRC. The patient is also responsible for their health. There are gaps between populations in the process of further investigation.
Conclusions: There are gaps between populations in the follow-up process.
There is a need to improve the processes that ensure patient adherence to recommendations.
There is a need to improve the processes that ensure patient adherence to recommendations.
Recommendations: To develop targeted intervention among low socioeconomic groups and an Arab sector.
Develop a process to ensure adherence to colonoscopy, including computerized support.
To ensure the patient's understanding of the FOBT test and the results.
To built prioritization system for colonoscopy after a positive finding.
Develop a process to ensure adherence to colonoscopy, including computerized support.
To ensure the patient's understanding of the FOBT test and the results.
To built prioritization system for colonoscopy after a positive finding.
Research number: R/153/2015
Research end date: 02/2018