Patient Perspectives on Barriers and Facilitators to 1-year Surveillance Colonoscopy Completion in Survivors of Colorectal Cancer: A Multimethod Analysis
Bibliographic record
Abstract
BACKGROUND: Patients treated for stage I to III colorectal cancer are at high risk for developing new and recurrent colon cancers. Therefore, professional organizations recommend a surveillance colonoscopy approximately 1-year postsurgical resection to ensure early detection. Despite these guidelines, surveillance colonoscopy completion rates remain suboptimal. OBJECTIVE: This multimethods study aimed to explore patient-identified barriers and facilitators affecting the completion of 1-year surveillance colonoscopies among stage I to III colorectal cancer survivors. DESIGN: Multimethods study. SETTINGS: The study was conducted within the Hutchinson Institute for Cancer Outcomes Research Value in Cancer Care Network, which comprises 46 clinics across 13 counties in Washington State. PATIENTS: We enrolled stage I to III colorectal cancer survivors who had not completed surveillance colonoscopy within 18 months of surgery. Participants completed questionnaires and semistructured interviews between December 2023 and June 2024. MAIN OUTCOME MEASURES: Questionnaire data and interview transcripts were independently coded and analyzed by 2 coders to identify key themes and subthemes related to barriers and facilitators of surveillance colonoscopy completion. RESULTS: The study included 19 patients. The median (interquartile range) participant age was 73 (17.8) years, 9 (47.4%) were men, and 8 (42.1%) had stage I cancer. All participants reported cognitive and environmental factors as both barriers and facilitators to surveillance colonoscopy completion. The most reported barriers were fear of the colonoscopy results and cancer recurrence (cognitive) and challenges with the bowel preparation (environmental). The most frequently reported facilitators were patient's motivation to receive reassurance (cognitive) and clinic assistance in scheduling appointments (environmental). LIMITATIONS: Results may not be generalizable due to population and selection bias of participants. CONCLUSIONS: This study identified barriers and facilitators to completing a 1-year surveillance colonoscopy, which will guide future interventions. Addressing both psychological concerns and improving communication between patients and clinics could be key strategies to enhance adherence rates and improve long-term outcomes for colorectal cancer survivors. See Video Abstract . PERSPECTIVAS DE LOS PACIENTES SOBRE LAS BARRERAS Y LOS FACILITADORES PARA COMPLETAR LA COLONOSCOPIA DE SEGUIMIENTO AL AO EN SUPERVIVIENTES DE CNCER COLORRECTAL UN ANLISIS MULTIMTODO: ANTECEDENTES:Los pacientes tratados por cáncer colorrectal en estadio I-III corren un alto riesgo de desarrollar nuevos cánceres de colon y de que estos reaparezcan. Por lo tanto, las organizaciones profesionales recomiendan una colonoscopia de vigilancia aproximadamente un año después de la resección quirúrgica para garantizar la detección precoz. A pesar de estas directrices, las tasas de realización de colonoscopias de vigilancia siguen siendo insuficientes.OBJETIVO:Este estudio multimétodo tenía como objetivo explorar las barreras y los facilitadores identificados por los pacientes que afectan a la realización de colonoscopias de vigilancia al año entre los supervivientes de cáncer colorrectal en estadio I-III.DISEÑO:Estudio multimétodo.ENTORNO:El estudio se llevó a cabo en el Hutchinson Institute for Cancer Outcomes Research Value in Cancer Care Network, que comprende 46 clínicas en 13 condados del estado de Washington.PACIENTES:Se inscribieron supervivientes de cáncer colorrectal en estadio I-III que no habían completado la colonoscopia de vigilancia en los 18 meses posteriores a la cirugía. Los participantes completaron cuestionarios y entrevistas semiestructuradas entre diciembre de 2023 y junio de 2024.PRINCIPALES MEDIDAS DE RESULTADOS:Los datos de los cuestionarios y las transcripciones de las entrevistas fueron codificados y analizados de forma independiente por dos codificadores para identificar los temas y subtemas clave relacionados con las barreras y los facilitadores de la realización de la colonoscopia de vigilancia.RESULTADOS:El estudio incluyó a diecinueve pacientes. La mediana (rango intercuartílico) de la edad de los participantes fue de 73 (17,8) años, 9 (47,4 %) eran hombres y 8 (42,1 %) tenían cáncer en estadio I. Todos los participantes informaron de factores cognitivos y ambientales como barreras o facilitadores para completar la colonoscopia de vigilancia. Las barreras más mencionadas fueron el miedo a los resultados de la colonoscopia y a la recurrencia del cáncer (cognitivo) y las dificultades con la preparación intestinal (ambiental). Los facilitadores más frecuentes fueron la motivación del paciente para recibir tranquilidad (cognitivo) y la ayuda de la clínica para programar las citas (ambiental).LIMITACIONES:Los resultados pueden no ser generalizables debido al sesgo de selección de la población y de los participantes.CONCLUSIONES:Este estudio identificó barreras y facilitadores para completar una colonoscopia de vigilancia anual con el fin de orientar futuras intervenciones. Abordar las preocupaciones psicológicas y mejorar la comunicación entre los pacientes y las clínicas podrían ser estrategias clave para mejorar las tasas de adherencia y los resultados a largo plazo de los supervivientes de cáncer colorrectal. ( AI-generated translation ).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".