P233 Barriers and facilitators to colonoscopy in patients and endoscopists

Introduction

Colorectal cancer (CRC) is the third most diagnosed cancer and the second most common cause of cancer related mortality worldwide. Most CRCs have a precursor in the form of a polyp which is endoscopically resectable. Yet many people refuse to have a colonoscopy when indicated. Research has been exploring the barriers and facilitators to screening colonoscopy, but rarely are surveillance or symptomatic populations studied.

Methods

Using inductive interpretative/constructionist qualitative research methods we explore the barriers and facilitators to colonoscopy in patients offered colonoscopy for a range of indications, and endoscopists. Recruitment was via advertising on social media, charity websites and email. Focus groups and interviews were conducted by one researcher, a Gastroenterology Research Fellow. A semi-structured format was used to perform focus groups and interviews, with questions initially generated from an understanding of the available literature. Thematic analysis was performed consecutively, with the interview questions evolving as themes emerged. Data collection continued until a saturation of new information was achieved.

Results

A patient focus group contained 11 participants, and 4 in the endoscopist focus group. Thirty patient and 8 endoscopist interviews were conducted. Preliminary analysis of the initial nodes generated are included below (nodes in italics are both barriers and facilitators).

Barriers

1. Pain • Bowel preparation • Online information – google, forums, social media, YouTube • Sedative effects – loss of control, amnesia, side effects • Loss of dignity • Embarrassment • Time out of life/work – bowel preparation, procedure, recovery • Inconvenience to others/family • Experience of others – family members & friends • Prior experience • Risk of complications • Lack of knowledge – risk/benefits • Fear of the unknown • Financial cost – missed work, travel, childcare • Fear of the results • Health considerations • Cultural differences

• COVID-19

Facilitators

• Fear of the results/cancer • Want explanation for symptoms • Trust in healthcare professionals • Experience of others – family members & friends • Prior experience • Lack of knowledge of alternatives • Knowledge about the benefits • Needing therapeutics • COVID-19 – time to think about symptoms

Conclusions

We highlight several target areas that may improve adherence to colonoscopy. Pain is a common theme in both patients and endoscopist which would benefit from further research. Lower discomfort procedures could reduce the need for sedation. Bowel preparation is a necessary process for colonoscopy and newer preparations may help. Improving the education and information given to patients, including variable formats, may reduce the number who seek information from poor sources online or from others.