Patient Perspectives on Barriers and Facilitators to 1-year Surveillance Colonoscopy Completion in Survivors of Colorectal Cancer: A Multi-Method Analysis

BACKGROUND: Patients treated for stage I-III colorectal cancer are at high risk for developing new and recurrent colon cancers. Therefore, professional organizations recommend a surveillance colonoscopy approximately 1-year post-surgical resection to ensure early detection. Despite these guidelines, surveillance colonoscopy completion rates remain suboptimal. OBJECTIVE: This multi-methods study aimed to explore patient-identified barriers and facilitators affecting the completion of 1-year surveillance colonoscopies among stage I-III colorectal cancer survivors. DESIGN: Multi-methods study. SETTINGS: The study was conducted within the Hutchinson Institute for Cancer Outcomes Research Value in Cancer Care Network, comprising 46 clinics across 13 counties in Washington State. PATIENTS: We enrolled stage I–III colorectal cancer survivors who had not completed surveillance colonoscopy within 18 months of surgery. Participants completed questionnaires and semi-structured interviews between December 2023 and June 2024. MAIN OUTCOME MEASURES: Questionnaire data and interview transcripts were independently coded and analyzed by two coders to identify key themes and subthemes related to barriers and facilitators of surveillance colonoscopy completion. RESULTS: The study included nineteen patients. The median (interquartile range) participant age was 73 (17.8) years, 9 (47.4%) were male and 8 (42.1%) had stage I cancer. All participants reported cognitive and environmental factors as barriers or facilitators to surveillance colonoscopy completion. The most reported barriers were fear of the colonoscopy results and cancer recurrence (cognitive) and challenges with the bowel preparation (environmental). The most frequently reported facilitators were patient’s motivation to receive reassurance (cognitive) and clinic assistance in scheduling appointments (environmental). LIMITATIONS: Results may not be generalizable due to population and selection bias of participants. CONCLUSIONS: This study identified barriers and facilitators to completing a 1-year surveillance colonoscopy to guide future interventions. Addressing both psychological concerns and improving communication between patients and clinics could be key strategies to enhance adherence rates and improve long-term outcomes for colorectal cancer survivors. See Video Abstract .