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Compliance, attitudes and barriers to post‐operative colorectal cancer follow‐up
Author(s) -
Cardella Jonathan,
Coburn Natalie G.,
Gagliardi Anna,
Maier BarbaraAnne,
Greco Elisa,
Last Linda,
Smith Andrew J.,
Law Calvin,
Wright Frances
Publication year - 2008
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/j.1365-2753.2007.00880.x
Subject(s) - medicine , guideline , colonoscopy , colorectal cancer , family medicine , confusion , carcinoembryonic antigen , medline , health care , cancer , intensive care medicine , pathology , psychology , political science , psychoanalysis , law , economics , economic growth
Rationale Meta‐analyses demonstrate that surveillance following curative‐intent colorectal cancer (CRC) surgery can improve survival. Our multidisciplinary team adopted a stringent CRC follow‐up (FU) guideline in 2000. The purpose of this study was to assess adherence and barriers to FU for CRC. Methods Patients with primary CRC aged 19–75 years, treated with curative intent surgery from July 2000 to December 2002 were identified from a prospective database. Compliance with FU was assessed primarily by chart review. We also surveyed patients and providers to explore attitudes and barriers to surveillance adherence using tenets of the Health Belief Model. Results 96 patients met inclusion criteria and were appropriate for FU. Median FU was 34 months. Guideline targets were met for 70% of clinic visits; 49% of carcinoembryonic antigen (CEA) determinations; and 62% of abdominal imaging studies. Post‐operative colonoscopy did not occur in 6/93 patients. Seventy per cent of health care providers and 55% of patients completed a survey. Access to testing and confusion about which provider orders investigations were identified as important barriers to FU. Conclusion Patterns of CRC FU were widely variable despite implementation of a guideline. Despite patient and provider agreement with the principles of CRC FU, adoption was inhibited by confusion among multiple providers regarding investigation coordination.