Patient participation in colon cancer screening programs

Background. The objectives of this study were to survey compliance and iden tify factors that influence continued participation with periodic colon can cer screening guidelines once patients are seen for their first screening. Methods. The study group consisted of 95 patients who had initial fecal occ ult blood tests (FOBT) and flexible sigmoidoscopy (FS) in 1991 as part of a gastroenterologist-directed, aggressively managed colon cancer screening r egistry. Regular notices are sent to patients and their primary care provid er for annual FOBT and FS at 3- to 5-year intervals. Results. Of 70 (74%) reviewed, 2 had died and 3 were having colonoscopic su rveillance. Thirty-two of the 65 (49%) contacted eligible study subjects we re no longer participating. Reasons stated were as follows: unaware that sc reening was due (14), too busy (6), unpleasant experience (3), and change t o insurance provider that did not cover screening (9 [commercial-3, managed care-1, Medicare-5]). Conclusions. Despite aggressive program management, 44% of nonparticipators reported that they were unaware that screening was due. Sixteen percent of those who did not continue to participate had graduated to Medicare, which did not cover screening costs. Factors that influence continued participat ion need to be considered in the design of public education and marketing p romotions.