Abstract
Background
A recommendation to undergo a colonoscopy, an invasive procedure that requires commitment and motivation, planning (scheduling and finding a driver) and preparation (diet restriction and laxative consumption), may be uniquely challenging for individuals with multiple chronic conditions (MCCs). This qualitative study aimed to describe the barriers and facilitators to colonoscopy experienced by such patients.
Materials and methods
Semistructured focus groups were conducted with male Veterans who were scheduled for outpatient colonoscopy and either failed to complete the procedure or completed the examination. Focus group recordings were transcribed and analyzed by an inductive grounded approach using constant comparative analysis.
Results
Forty-four individuals aged 51–83 years participated in this study (23 adherent and 21 nonadherent). Participants had an average of 7.4 chronic conditions (range 2–14). The five most common chronic conditions were hypertension (75%), hyperlipidemia (75%), osteoarthritis/degenerative joint disease (59%), atherosclerotic heart disease (48%), and diabetes mellitus (36%). We identified four unique themes that influenced motivation to undergo a colonoscopy: competing medical priorities, low perceived benefit, a prior negative colonoscopy experience, and pre-existing medical conditions. Additionally, we identified four themes that influenced individuals’ ability to complete the examination: difficulty with bowel cleansing, difficulty with travel, worry about exacerbation of pre-existing conditions, and heightened concerns about potential complications.
Conclusion
MCCs are common in individuals referred for colonoscopy and generate unique barriers to colonoscopy completion related to medication, dietary changes, transportation, preparation processes, symptoms exacerbation, and complication concerns. Future research should examine whether tailored interventions that include education and support in addressing the unique barriers can enhance colonoscopy completion.
Supplementary material
Table S1 Primary analysis and coding tree
Acknowledgments
The authors would like to thank the individuals who participated in this study and Ms Lexi Charnas for her assistance with study recruitment. This material is the result of work supported with resources and the use of facilities at the Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, USA, and the Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, USA. This work was supported by Career Development Award 10-022 from the Department of Veterans Affairs Health Services Research and Development (S Sultan). Dr Partin is supported by a Department of Veterans Affairs Health Service Research and Development Award, RCS 10-185. The funding source had no role in the study design, collection, analysis or interpretation of the data, writing of the report, or the decision to submit this article for publication. The contents do not represent the views of the US Department of Veterans Affairs or the United States Government.
Author contributions
SS, RB, BC, CN, and SF contributed to conception and design. IMF, SS, RB, and JL contributed to analysis and interpretation of data. SS, MP, BC, RB, IMF, and JL contributed to drafting of the article. SS, MP, BC, RB, IMF, JL, and CN contributed to critical revision of the article for important intellectual content. All authors contributed to final approval of the article. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.