P2150 - Bowel Preparation Hesitancy Identified as Biggest Barrier to Screening Colonoscopy: Results from a Large Online Survey of Patients Who Complete Colonoscopy
Audrey H. Calderwood, MD, MS1, Douglas Rex, MD2, Daniel L. Halberg, PhD3, Andrew Swanson, 4, Casey Le, 5, Chris Evans, 5, Erin Peterson, 5 1Dartmouth Hitchcock Medical Center, Lebanon, NH; 2Indiana University School of Medicine, Indianapolis, IN; 3Sebela Pharmaceuticals, Braintree, MA; 4Braintree Laboratories, Inc., Braintree, MA; 5Colon Cancer Coalition, Minneapolis, MN
Introduction: A colonoscopy is an important screening option for colorectal cancer (CRC); however, the effectiveness of colonoscopy is dependent on adequate bowel prep. Unfortunately, one in four colonoscopies may be incomplete due to insufficient prep which negatively affects adenoma detection rates (ADR), procedure time, need for repeat exams, and cost. This study examines challenges and barriers to colonoscopy, including the bowel prep process and if that may affect a patient’s adherence to future colonoscopy screening.
Methods: The survey was conducted online from 12/2023-3/2024 of adults over the age of majority in the US who have completed a colonoscopy. 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 consisted of 30 questions exploring the experience with colonoscopy, including the bowel prep process.
Results: Of the 1,613 respondents, half underwent average-risk screening (n=758) and 25% (n=401) had early or more frequent screenings due to family history of CRC. The majority (86%) cited the colon prep process as the most challenging part of colonoscopy. Other challenges included the unpleasantness of prep (49%), fear of the results (23%), taking time off work (15%), fear of the procedure (14%), and transportation (12%). Still, 26% reported no challenges to completing the colonoscopy. In terms of bowel prep, 62% were aware of there being multiple bowel prep options, yet 75% were not given a choice by their provider. While 82% (n=1335) did not see prep as a barrier to completing the colonoscopy in spite of the challenges it presents, there was still hesitancy related to drinking the prep (53%), the prep volume (47%), physical response (38%), and time spent on the toilet (37%). Free text responses reiterated this as participants recognized the need to endure the taste and volume of prep and recognized colonoscopy as a potentially life-saving procedure (n=1072).
Discussion: This large survey found that colonoscopy patients perceive the bowel prep to be the worst part of the colonoscopy experience. Anxiety around colonoscopy is primarily driven by perceptions around completing the prep medication due to taste, volume, and/or side effects. Ultimately, however, many patients are able to overcome prep hesitancy to complete a colonoscopy. Improving access to well-tolerated bowel prep options may continue to decrease perceived barriers to screening colonoscopy.
Figure: Figure 1: Challenges in Completing a Colonoscopy (Respondents' Top Three Choices Summarized) *Other Includes: Cost of the Procedure, Unpleasantness of Procedure, Lack of Knowledge, and/or Other Responsibilities
Disclosures:
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.
Audrey H. Calderwood, MD, MS1, Douglas Rex, MD2, Daniel L. Halberg, PhD3, Andrew Swanson, 4, Casey Le, 5, Chris Evans, 5, Erin Peterson, 5. P2150 - Bowel Preparation Hesitancy Identified as Biggest Barrier to Screening Colonoscopy: Results from a Large Online Survey of Patients Who Complete Colonoscopy, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
