Douglas Rex, MD1, Audrey H. Calderwood, MD, MS2, Daniel L. Halberg, PhD3, Andrew Swanson, 4, Casey Le, 5, Chris Evans, 5, Erin Peterson, 5 1Indiana University School of Medicine, Indianapolis, IN; 2Dartmouth Hitchcock Medical Center, Lebanon, NH; 3Sebela Pharmaceuticals, Braintree, MA; 4Braintree Laboratories, Inc., Braintree, MA; 5Colon Cancer Coalition, Minneapolis, MN
Introduction: Colorectal Cancer (CRC) has been identified as the “most preventable, yet least prevented” form of cancer, with an estimated death from CRC every 10 minutes in the U.S. The current standard for CRC screening is 80% in every community, yet screening rates, and the use of colonoscopy, continue to lag behind this mark. A thorough bowel prep is crucial for an effective colonoscopy. Unfortunately, one in four colonoscopies may be incomplete due to insufficient prep, often requiring the patient to repeat the procedure. This study examines how people who have not had colonoscopies view the bowel prep process and if that may affect their adherence to CRC screening.
Methods: We conducted an online survey from 12/2023-3/2024 of adults over the age of majority in the US. The survey was promoted through the Colon Cancer Coalition’s social media channels and emailed to the network of patients, survivors, caregivers, volunteers, and community partners. The survey was open to all regardless of colonoscopy experience. Of the 1897 survey responses, 252 subjects indicated they had not had a colonoscopy. These respondents were asked 27 questions exploring their perceptions of colonoscopy, including the bowel preparation process.
Results: Of the 252 subjects indicating they had not had a colonoscopy, 46% (n=115) of subjects indicated being under the age of 45 as the reason for not having a colonoscopy. Of the remaining respondents (n=137) 45% indicated the colon prep as the reason for avoiding a colonoscopy and 42% responded that their doctor had not yet recommended a colonoscopy. When asked about perceived challenges for completing a colonoscopy, 59% cited prep tolerability and 56% anticipated that the colon prep would be difficult or very difficult. 41% indicated that their feelings about the prep influenced their decision to not have a colonoscopy, listing their physical response to the medication (64%), drinking the large volume (56%), and time spent on the toilet (48%) as the top three reasons for hesitancy.
Discussion: In our survey among adults who have not yet had a screening colonoscopy, bowel prep hesitancy and lack of physician recommendation emerged as the two most important barriers to colonoscopy screening. Improving access to well-tolerated bowel prep options, increasing primary care awareness, and education around screening recommendations would likely reduce resistance among patients.
Figure: Figure 1: Reason Subjects Over 45 Had Not Gotten a Colonoscopy
Audrey Calderwood indicated no relevant financial relationships.
Daniel Halberg: Sebela Pharmaceuticals – Employee.
Andrew Swanson: Braintree Laboratories, Inc. – Employee.
Casey Le indicated no relevant financial relationships.
Chris Evans indicated no relevant financial relationships.
Erin Peterson indicated no relevant financial relationships.
Douglas Rex, MD1, Audrey H. Calderwood, MD, MS2, Daniel L. Halberg, PhD3, Andrew Swanson, 4, Casey Le, 5, Chris Evans, 5, Erin Peterson, 5. P2151 - Factors Associated With Colonoscopy Hesitancy Among Adults Who Have Not Undergone Screening: Results of a Large Online Survey, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
