Hispanic Patients Reported Factors for Colonoscopy "No-Shows" Despite a Culturally Tailored Patient Navigation Program.

Abstract

Background: Multiple studies have been conducted to understand patient-specific barriers to adequate colorectal cancer screening; however, few have offered in-depth reflections directly from patients who have "no-show" to their colonoscopy appointments. This observational study was designed to identify reasons for missed or canceled colonoscopy appointments among Hispanic patients enrolled in our culturally tailored patient navigation program (CTPNP).

Methods: Hispanic patients scheduled for a colonoscopy in the CTPNP at Roger Williams Medical Center in Providence, RI, from 2016 to 2019 were followed. Patients who missed or canceled their colonoscopy appointments underwent semi-structured interviews to identify the reason for the no-show or cancellation.

Results: Out of the 698 Hispanic patients enrolled in the CTPNP, 85% completed colonoscopy; however, 15% (n = 104) canceled or missed their colonoscopy. The most common reasons for cancellation were financial constraints at 24% (n = 25), transportation at 11.6% (n = 12), family health problems at 7.8% (n = 10), relocation at 8.6% (n = 9), fear of procedure at 8.6% (n = 9) or performed at different facility 6.7% (n = 7). 18% of patients who missed colonoscopy appointments (n = 19) could not be contacted.

Conclusion: Financial constraints are the most common reported reason for missed colonoscopy in Hispanic patients.

Policy implications: Financial barriers remain the most critical barrier to colonoscopy. Copays and charges for a diagnostic colonoscopy instead of a screening colonoscopy were also reported as barriers. Since this work, a bill has passed in RI to address this gap in coverage, requiring insurance companies to cover costs for all colorectal screening, whether classified as screening or diagnostic.