Su1033 Factors Associated With Colon Cancer Testing: the 2009 California Health Inventory Survey

ive fecal occult blood testing (FOBT) should be discussed. Nationally, it is estimated that approximately 60% of age-appropriate adults have had a colonoscopy. The purpose of this quality improvement (QI) project is to determine how many age-appropriate patients in the residency continuity clinic at Lankenau Medical Center have had a colonoscopy, and stratify reasons for those that have not. Additionally, we will prove that yearly highly sensitive FOBT is underutilized as a simple, low-cost, non-invasive method for CRC screening in patients that are unable to or refuse to have a colonoscopy. Methods Electronic medical records (EMR) were reviewed for patients aged 50-90 that were seen in the clinic over a 6 month period, without regard for gender or ethnicity. For those that had a documented colonoscopy, no further review was performed. Those that did not have documentation in the hospital or clinic EMR received a phone call. For patients that reported never having a colonoscopy, the reason was obtained. Additionally, these patients were asked if an alternative screening method was discussed, with a focus on FOBT. Results Information was obtained for 558 patients. Of them, 79.75% had documentation of a colonoscopy, or reported that they had one. Of the remaining 20.25% who never had a colonoscopy, the most common reasons were insurance limitations, fear of or not wanting procedure, other medical issues taking precedence, and “no reason”. Nearly 17% failed to follow-up after being given a referral. Only 10.6% of patients in this subgroup were informed of an alternative screening method, such as FOBT. Conclusion FOBT is low cost, non-invasive and can be performed at home, making it a viable alternative for patients who are unable to or not willing to get a colonoscopy. Stool-based tests improve prognosis by detecting early cancers and potentially advanced adenomas. The sensitivity for detecting CRC with highly sensitive FOBT is 80-92%, and there has been shown to be a 33% CRC mortality reduction at 13 years with yearly FOBT. While disadvantages of the test include a high number of false positives that warrant further workup, as well an inability to detect non-bleeding polyps, with proper counseling and follow-up FOBT is an acceptable alternative for CRC screening when colonoscopy is not readily feasible. Reasons Reported by Patients for Not Having a Colonoscopy