Causes and Impact of Missing Follow-Up Colonoscopy

Missing a follow-up colonoscopy has been identified as a type of missed opportunity in cancer diagnosis. Missed opportunities are instances in which later analysis indicates that different decisions or actions could have produced a quicker diagnosis,1 emphasizing the value of timely screening. Learn more below about contributing factors to missed opportunities during follow-up and coordination.

It's estimated that 1 in 20 adults receiving outpatient care in the US are affected by missed opportunities2

Colon cancer is associated with a greater risk of avoidable delay2

Missed opportunities can be reduced when patients are appropriately empowered and shared decision making is used1,3

A timely follow-up colonoscopy after a positive stool-based test (SBT) is needed to complete the screening process. Several recent studies highlight the clinical benefit of conducting an SBT as part of CRC screening, including:

  • Increasing the predicted life-years gained (LYG)/colonoscopy per 1000 individuals from 0.09 for screening colonoscopy to 0.29 for follow-up colonoscopy4
  • Enriching the frequency of advanced findings at a follow-up colonoscopy, with more polyps and more CRC found in those with a preceding positive SBT than those who received screening colonoscopies alone5

Despite this, research suggests that rates of follow-up colonoscopy screening after a positive SBT result are low.6,7 In light of these findings, it’s crucial to understand the causes and impact of missed follow-up colonoscopies.

Missed opportunities and contributing factors during follow-up and coordination

Patient factors1

  • Many patients don’t know how to, or lack empowerment, to access their own test results
  • Some patients mistakenly interpret a lack of communication or follow-up from HCPs to mean that “all is normal”
  • Even if patients experience worsening symptoms, they may not be willing to re-consult or seek a second opinion

Expecting patients to ‘call back’1

  • HCPs often assume patients will seek further consultation if their symptoms don’t improve or new symptoms develop; they assume their diagnosis was correct if they don’t hear otherwise
  • Missed opportunities that stem from coordination failures between different healthcare facilities and clinics could be prevented by ensuring timely patient follow-up

Failure to follow-up on abnormal test results1

  • The failure to identify and act on abnormal test results related to cancer is increasingly recognized in healthcare systems that use electronic health records
    • Many factors could contribute to this—for example, HCPs experiencing ‘alert fatigue,’ or a lack of clearly assigned responsibilities regarding patient follow-up

Missed opportunities occur in a substantial number of patients, causing delays in diagnosis1

Both preventable missed diagnostic opportunities and delayed or wrong diagnosis with no clear evidence of missed opportunities can cause patient harm.

Related Topics

Footnotes


List of definitions

CRC: colorectal cancer; HCP: healthcare professional; LYG: life-years gained; SBT: stool-based test; US: United States.


References

  1. Lyratzopoulos G, Vedsted P, Singh H. Understanding missed opportunities for more timely diagnosis of cancer in symptomatic patients after presentation. Br J Cancer. 2015;112(Suppl 1):S84-S91.
  2. Swann R, Lyratzopoulos G, Rubin G, Pickworth E, McPhail S. The frequency, nature and impact of GP-assessed avoidable delays in a population-based cohort of cancer patients. Cancer Epidemiol. 2020;64:101617.
  3. Patel SG, May FP, Anderson JC, et al. Updates on age to start and stop colorectal cancer screening: recommendations from the US Multi-Society Task Force on Colorectal Cancer. Gastroenterol. 2022;162(1):285-299.
  4. Fendrick AM, Borah BJ, Burak Ozbay A, Saoud L, Limburg PJ. Life-years gained resulting from screening colonoscopy compared with follow-up colonoscopy after a positive stool-based colorectal screening test. Prev Med Rep. 2022;19(26):101701.
  5. Anderson JC, Robinson CM, Hisey W, Limburg PJ, Butterly LF. Colonoscopy findings in FIT+ and mt-sDNA+ patients versus in colonoscopy-only patients: New Hampshire Colonoscopy Registry data. Cancer Prev Res. 2022;15(7):455-464.
  6. Austin G, Kowalkowski H, Guo Y, et al. Patterns of initial colorectal cancer screenings after turning 50 years old and follow-up rates of colonoscopy after positive stool-based testing among the average-risk population. Curr Med Res Opin. 2023;39(1):47-61.
  7. Mohl JT, Ciemins EL, Miller-Wilson LA, Gillen A, Luo R, Colangelo F. Rates of follow-up colonoscopy after a positive stool-based screening test result for colorectal cancer among health care organizations in the US, 2017-2020. JAMA Netw Open. 2023;6(1):e2251384.