A Qualitative Study of Staff and Provider Experiences with Follow-up Colonoscopy in a Community Health Center and Gastroenterology Specialty

Colorectal cancer screening is an effective strategy to prevent disease, reduce the risk of advanced-stage diagnosis, and improve survival. Timely follow-up of abnormal screening results, particularly abnormal fecal immunochemical tests, is essential to realizing these benefits. This qualitative study examined routine processes related to colonoscopy referral and completion for patients of a federally qualified health center (FQHC) referred to community gastroenterology (GI) practices. Using a snowball sampling approach, five FQHC individuals and eight community GI practice individuals were interviewed. Interviews at the FQHC were conducted between March 2020 and September 2021, during the early phase of the coronavirus disease 2019 pandemic. Due to clinic closures and other pandemic-related disruptions, GI practice interviews occurred between August 2021 and January 2023. Study findings highlight the need for improved communication and collaboration between primary care and GI practices to support colonoscopy completion among low resource populations. Interviewees also offered recommendations to ensure colonoscopy completion. Further research is needed to pilot test centralized referral and scheduling systems and to develop multicomponent interventions that address both patient and organizational barriers to colonoscopy completion.