Barriers to colonoscopy in remote northern Canada: an analysis of cancellations

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ABSTRACT

Background: Colonoscopy is a critical diagnostic and therapeutic procedure that is challenging to access in northern Canada. In part, this is due to frequent cancellations. We sought to understand the trends and reasons for colonoscopy cancellations in the Northwest Territories (NWT).

Methods: A retrospective review of colonoscopy cancellations January, 2018 to May, 2019 was conducted at Stanton Territorial Hospital, NWT. Cancellation details and rationale were captured from the endoscopy cancellation logs. Thematic analysis was used to group cancellation reasons. Descriptive statistics were generated, and trends were analysed using run chart.

Results: Of the scheduled colonoscopies, 368(28%) were cancelled during the 16 month period, and cancellations occurred, on average, 27 days after booking. Cancellation reasons were grouped into 15 themes, encompassing personal, social, geographic and health system factors. The most frequently cited theme was work/other commitments (69 respondents; 24%). Cancellations due to travel and accommodation issues occurred more frequently in the winter.

Conclusion: Over one in four booked colonoscopies were cancelled and the reasons for cancellations were complex. Initiatives focusing on communication and support for patients with personal or occupational obligations could dramatically reduce cancellations. Ongoing collaborative efforts are needed to inform and optimise access to colonoscopy in this region.

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Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (hemoccult): an update.

Les Irwig, Paul Hewitson, Paul Glasziou … (2008)

Reducing mortality from colorectal cancer (CRC) may be achieved by the introduction of population-based screening programs. The aim of the systematic review was to update previous research to determine whether screening for CRC using the fecal occult blood test (FOBT) reduces CRC mortality and to consider the benefits, harms, and potential consequences of screening. We searched eight electronic databases (Cochrane Library, MEDLINE, EMBASE, CINAHL, PsychINFO, AMED, SIGLE, and HMIC). We identified nine articles describing four randomized controlled trials (RCTs) involving over 320,000 participants with follow-up ranging from 8 to 18 yr. The primary analyses used intention to screen and a secondary analysis adjusted for nonattendance. We calculated the relative risks and risk differences for each trial, and then overall, using fixed and random effects models. Combined results from the four eligible RCTs indicated that screening had a 16% reduction in the relative risk (RR) of CRC mortality (RR 0.84, 95% confidence interval [CI] 0.78-0.90). There was a 15% RR reduction (RR 0.85, 95% CI 0.78-0.92) in CRC mortality for studies that used biennial screening. When adjusted for screening attendance in the individual studies, there was a 25% RR reduction (RR 0.75, 95% CI 0.66-0.84) for those attending at least one round of screening using the FOBT. There was no difference in all-cause mortality (RR 1.00, 95% CI 0.99-1.02) or all-cause mortality excluding CRC (RR 1.01, 95% CI 1.00-1.03). The present review includes seven new publications and unpublished data concerning CRC screening using FOBT. This review confirms previous research demonstrating that FOBT screening reduces the risk of CRC mortality. The results also indicate that there is no difference in all-cause mortality between the screened and nonscreened populations.

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Why we don't come: patient perceptions on no-shows.

Naomi L Lacy, Audrey Paulman, Matthew Reuter … (2024)

Patients who schedule clinic appointments and fail to keep them have a negative impact on the workflow of a clinic in many ways. This study was conducted to identify the reasons patients in an urban family practice setting give for not keeping scheduled appointments.

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Is Open Access

Residential schools and the effects on Indigenous health and well-being in Canada—a scoping review

Piotr Wilk, Alana Maltby, Martin Cooke (2017)

Background The history of residential schools has been identified as having long lasting and intergenerational effects on the physical and mental well-being of Indigenous populations in Canada. Our objective was to identify the extent and range of research on residential school attendance on specific health outcomes and the populations affected. Methods A scoping review of the empirical peer-reviewed literature was conducted, following the methodological framework of Arksey and O’Malley (2005). For this review, nine databases were used: Bibliography of Native North Americans, Canadian Health Research Collection, CINAHL, Google Scholar, Indigenous Studies Portal, PubMed, Scopus, Statistics Canada, and Web of Science. Citations that did not focus on health and residential school among a Canadian Indigenous population were excluded. Papers were coded using the following categories: Indigenous identity group, geography, age-sex, residential school attendance, and health status. Results Sixty-one articles were selected for inclusion in the review. Most focused on the impacts of residential schooling among First Nations, but some included Métis and Inuit. Physical health outcomes linked to residential schooling included poorer general and self-rated health, increased rates of chronic and infectious diseases. Effects on mental and emotional well-being included mental distress, depression, addictive behaviours and substance mis-use, stress, and suicidal behaviours. Conclusion The empirical literature can be seen as further documenting the negative health effects of residential schooling, both among former residential school attendees and subsequent generations. Future empirical research should focus on developing a clearer understanding of the aetiology of these effects, and particularly on identifying the characteristics that lead people and communities to be resilient to them.

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Journal

Journal ID (nlm-ta): Int J Circumpolar Health

Journal ID (iso-abbrev): Int J Circumpolar Health

Title: International Journal of Circumpolar Health

Publisher: Taylor & Francis

ISSN (Print): 1239-9736

ISSN (Electronic): 2242-3982

Publication date (Electronic, pub): 20 September 2020

Publication date (Electronic, collection): 2020

Volume: 79

Issue: 1

Electronic Location Identifier: 1816678

Affiliations

[a ]Telfer School of Management, University of Ottawa; , Ottawa, ON, Canada

[b ]Department of General Surgery, University of Ottawa Faculty of Medicine; , Ottawa, ON, Canada

[c ]Faculty of Medicine, University of Ottawa; , Ottawa, ON, Canada

[d ]Department of General Surgery, Stanton Territorial Health Authority; , Yellowknife, NWT, Canada

[e ]Office of Research Services, MacEwan University; , Edmonton, AB, Canada

Author notes

CONTACT Heather Smith hsmit037@ 123456uottawa.ca Telfer School of Management, University of Ottawa; , Ottawa, ON, Canada

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equal contribution

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Heather Smith https://orcid.org/0000-0002-7736-4641

Nicole Brunet https://orcid.org/0000-0002-1088-5135

Alisha Tessier https://orcid.org/0000-0002-7864-8048

Robin Boushey https://orcid.org/0000-0002-8898-5515

Craig Kuziemsky https://orcid.org/0000-0003-3904-5372

Article

Publisher ID: 1816678

DOI: 10.1080/22423982.2020.1816678

PMC ID: 7534278

PubMed ID: 33290187

SO-VID: f8c097c8-07f1-41e1-9fd1-9b1af551695c

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This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Barriers to colonoscopy in remote northern Canada: an analysis of cancellations

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Most cited references 29

Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (hemoccult): an update.

Why we don't come: patient perceptions on no-shows.

Residential schools and the effects on Indigenous health and well-being in Canada—a scoping review

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Cited by 5

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