PWE-436 Understanding why the at-risk population do not take up colonoscopy following a positive screening test and attendance at nurse (ssp) assessment clinic within the bowel cancer screening programme (bcsp)

Introduction

The success of BCSP is dependent on ensuring that people with positive screening test results (positive FOB) go through for a colonoscopy. Consequently, a QA standard of 90% is set for the conversion rate of attendances of positive assessment (SSP) clinic to colonoscopy. The aim of this study was to understand for why our at-risk population that attended SSP clinic did not progress to colonoscopy.

Method

Following identification on BCSS, cases between 2/14 and 11/14 were audited using a standard profoma of attendances to clinic but non-conversion to colonoscopy to ascertain the reasons why. If necessary a follow up phone call by SSP was performed.

Results

Of the 532 patients that attended SSP clinic, the conversion rate to colonoscopy was 95%. Only 27 declined colonoscopy (Non-conversion rate 5.1%). The majority were male (n = 21; 78%) who were 2.5 fold more likely not to convert than females (non-conversion rate of 6.6% v 2.8% respectively). Geographically, two thirds of non-converters were from the Wirral, which is a more affluent, high uptake region compared to Liverpool. The non-conversion rate was 2.5 fold greater in the Wirral (7.6%) than in Liverpool (3.1%). The reasons for non-conversion were; personal reasons (22.2%), had a recent colonoscopy, (18.5%), treatment for another cancer (14.8%), wanted to wait for another test kit (11.1%), fear (7.4%), complex co-morbidities (7.4%), under another surveillance programme (3.7%) and travel involved (3.7%). Of total that attended clinic in Wirral only 0.8% found the travel to the Liverpool for colonoscopy an issue. The range of non-conversion amongst individual SSPs was 0–9.1%. Further telephone contact did not change the patient’s reasons for going onto colonoscopy.

Conclusion

This study confirms that females better embrace screening programmes. The reasons for non-conversion were diverse. Reassuringly a large proportion of reasons were understandable and the distance to travel for colonoscopy did not seem to be an issue. The higher rate of non-conversion in a higher uptake and socio-economic region is difficult explain but now specific health promotion can be targeted around the benefits of colonoscopy in this area. Telephone follow up of non-converters seems to be of no benefit. The overall excellent conversion rate of 95% reflects the high standard of SSP performance within the programme and little conclusion can be drawn from the range of non-conversion between individual SSPs which are likely to reflect statistical bias due to low numbers.

Disclosure of interest

None Declared.