1. We’ve previously demonstrated that female gender and Asian race are positively associated with colonoscopy completion within 1 year of an abnormal stool test for screening in this population. Several studies have suggested that women are more attentive to health care providers and more likely to adhere to their recommendations. We believe this to be the most likely reason for this observed association. Regarding, the observed effect of race on colonoscopy completion, this likely reflects a population of immigrants, who given the opportunity, are more likely to access any available resources.
We also demonstrated that those who were married were more likely to complete a colonoscopy within 1 year of an abnormal stool test. This was an intermediary determinant that made a lot of sense to us from the outset. The reason being, to complete a colonoscopy, a patient must have an adult to escort them out of the endoscopy unit as they are sedated and unable to drive home. Anyone who is unable to identify such a person is not allowed to complete the procedure. Those who are married are more likely to have reliable social support and thus have easier access to a person who can take them home after the procedure.
2. The level of a patient’s education could contribute to adherence to colonoscopy completion after an abnormal stool-test for screening. Stool-based screening tests are a 2-step process, so it is implicit that anyone with a positive test complete a colonoscopy. While it is very likely that some physicians don’t share this with patients at the time of screening, poor education could contribute to lack of understanding about how the stool test and colonoscopy works, the increased risk for cancer when the stool test is abnormal, and a false sense of completion because “a screening test” has been completed. Additionally, a patient’s educational status could impact their ability to communicate with physicians and navigate the healthcare system.