Factors Contributing to Non-Attendance of GI Endoscopic Procedures in a Tertiary Care Center in the Middle East.

INTRODUCTION: The cancer burden in the Middle East is high and growing. Colorectal cancer (CRC) is the second most common cancer for both men and women in the UAE. Although early diagnosis of malignancy reduces morbidity and increases the survival rates, non-attendance of gastroenterology (GI) endoscopic procedures is a significant global problem, which can lead to delay in cancer diagnosis and treatment. Several factors have been found to contribute to non-attendance behavior, including socioeconomic, cultural, and organizational related barriers. The purpose of this study was to identify factors contributing to non-attendance behavior among outpatients scheduled for GI endoscopic procedures in a tertiary hospital in the United Arab Emirates. We conclude with recommendations that can help in reducing the rate of patient no-shows for GI endoscopic procedures in the region. METHODS: In a tertiary medical center in the Middle East, we surveyed patients who did not attend their scheduled GI endoscopic procedures over a period of one year. The questionnaire sought to identify possible reasons for patient's non-attendance. Descriptive measures including means, standard deviation, frequencies, and percentages were used to analyze the demographic characteristics of the study participants. The chi-square test was performed to analyze gender differences. RESULTS: Of 314 outpatients who met study inclusion criteria, 168 agreed to participate (53.5% response rate). The majority of participants were women (n=96, 60.4 %), aged 18 to 73, with a mean of 42 years. The largest age group was between 35 and 44 (n=46, 28.9 %). Approximately equal numbers of non-attendance appointments were scheduled for combined colonoscopy and upper endoscopy (36.3 %), colonoscopy alone (31.3 %), or upper endoscopy alone (31.3 %). The most common causes for cancellation or non-attendance included concerns about the appointment (35.5%), inconvenient timing of the appointment (27.9%) and changes in medical status (26.4%). Gender differences were noted for non-attendance behaviors, with women significantly more likely than men to report feelings of embarrassment (Chi-square 6.261, df=1, p=.012). CONCLUSION: Our study has identified several barriers to patient attendance of endoscopic procedures, as well as opportunities to reduce the rate of patient no-shows, including patient education, scheduling options, and protocols to minimize discomfort and misconceptions around GI endoscopic procedures, particularly accommodating for same gender endoscopists, with the ultimate goal of increasing early cancer screening and prevention.

"Rescue" of Nonparticipants in Colorectal Cancer Screening: A Randomized Controlled Trial of Three Noninvasive Test Options.

Few studies have directly targeted nonparticipants in colorectal cancer screening to identify effective engagement strategies. We undertook a randomized controlled trial that targeted nonparticipants in a previous trial of average-risk subjects which compared participation rates for mailed invitations offering a fecal test, a blood test or a choice of either. Nonparticipants (n = 899) were randomized to be offered a kit containing a fecal immunochemical test (FIT), directions on how to arrange a blood DNA test, or the option of doing either. Screening participation was assessed 12 weeks after the offer. To assess the cognitive and attitudinal variables related to participation and invitee choice, invitees were surveyed after 12 weeks, and associations were investigated using multinomial logistic regression. Participation rates were similar between groups (P = 0.88): 12.0% for FIT (35/292), 13.3% for the blood test (39/293), and 13.4% for choice (39/290). Within the choice group, participation was significantly higher with FIT (9.7%, 28/290) compared with the blood test (3.8%, 11/290, P = 0.005). The only variable significantly associated with participation was socioeconomic status when offered FIT, and age when offered choice but there was none when offered the blood test. Survey respondents indicated that convenience, time-saving, comfort, and familiarity were major influences on participation. There was no clear advantage between a fecal test, blood test, or choice of test although, when given a choice, the fecal test was preferred. Differences in variables associated with participation according to invitation strategy warrant consideration when deciding upon an invitation strategy for screening nonparticipants. PREVENTION RELEVANCE: This trial of screening for those at average risk for colorectal cancer targeted past fecal-test nonparticipants and compared participation rates for mailed invitations offering a fecal test, blood test, or choice of either. Although there was no clear advantage between strategies, factors associated with participation differed between each strategy.

Patient Engagement with Interactive Text Message System Improves Successful Colonoscopy Rates in an Outpatient Endoscopy Center.

INTRODUCTION: Text message-based interventions reduce colonoscopy no-show rates and improve bowel preparation scores. In this non-randomized study, we assessed whether an interactive text messaging system could improve colonoscopy outcomes. METHODS: Colonoscopy pre-procedural instructions were programmed into a dedicated software platform created for this study. In the intervention arm, text messages were sent to veterans during a 4-week study period. Validated pre-procedural satisfaction questionnaires were completed by patients during standard protocol and intervention periods. Demographics and colonoscopy outcomes data were compared between the standard protocol and intervention arms, including procedure completion rate on scheduled date, Boston bowel preparation score (BPPS), adenoma detection rate, and satisfaction. RESULTS: Of 241 patients, 128 were in the standard protocol arm and 113 in the intervention arm. Higher proportions of patients receiving text messages underwent colonoscopy on their scheduled date (69.9%) compared to the ones in the standard protocol (50.8%, p = 0.015). Patients with ≥3 interactions with the system had 80.6% likelihood of completing colonoscopy on the scheduled date compared to 56.9% with <3 interactions and 50.8% with standard protocol (p < 0.001). Frequency of interaction with the system was similar between older (>65 years) and younger patients (p = 1.0). Among older patients, colonoscopy was completed successfully in 84.2% when alert-based human interactions occurred compared to 65.6% in those without and 47.9% with standard protocol (p = 0.018). More than 90% indicated they would recommend the system to patients undergoing future colonoscopy. CONCLUSION: An interactive text messaging system improves successful colonoscopy rates in a VA setting, with greatest impact in older patients.

How does COVID-19 fear and anxiety affect chemotherapy adherence in patients with cancer.

Aim: To investigate how COVID-19 fear and anxiety (COV-FA) affects chemotherapy adherence in patients with cancer. Materials & methods: The records of 3661 patients with chemotherapy (CT) appointments were retrospectively reviewed. Results: The CT postponement rates before and after COVID-19 were 11.6% and 14.2%, respectively (p = 0.017). The rate of COV-FA-related CT postponement after telemedicine was lower than that before (4.6% vs 17.4%; p = 0.012). The median time to come back to treatment of the COV-FA group was 47 days (range 19-72 days). Advanced age (≥60 years) was found to be the independent factor that was predictive of time to come back to treatment (p = 0.043). Conclusion: The CT postponement rate increased after COVID-19. COV-FA-related CT postponement decreased after telemedicine. Advanced age could be predictive of time to come back to treatment.

Factors Influencing Nonadherence to Recommended Postdischarge Follow-Up After Trauma.

INTRODUCTION: Historically, trauma patients have low adherence to recommended outpatient follow-up plans, which is crucial for improved long-term clinical outcomes. We sought to identify characteristics associated with nonadherence to recommended outpatient follow-up visits. METHODS: This is a single-center retrospective examination of inpatient trauma survivors admitted to a level 1 trauma center (March 2017-March 2018). Patients with known alternative follow-up were excluded. All outpatient visits within 1 y from the index admission were identified. The primary outcome was nonadherence, which was noted if a patient failed to follow-up for any specialty recommended in the discharge instructions. Factors for nonadherence studied included age, injury severity score, mechanism, length of stay, number of referrals made, and involvement with a Trauma Recovery Services program. Bivariate and logistic regression analyses were performed. RESULTS: A total of498 patients were identified (69% men, median age 43 y [range, 26-58 y], median injury severity score 14 [range, 9-19]). Among them, 240 (47%) were nonadherent. The most common specialties recommended were orthopedic surgery (56% referred, 19% nonadherent), trauma (54% referred, 35% nonadherent), and neurosurgery (127 referred, 35% nonadherent). Lowest levels of follow-up were seen for nonsurgical referrals. In adjusted analysis, a higher number of referrals made (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.95-3.05) and older age (OR, 1.01; 95% CI, 1.00-1.02) were associated with nonadherence. Trauma Recovery Service participants and penetrating trauma patients were more likely to be adherent (OR, 0.60; 95% CI, 0.37-0.97). CONCLUSIONS: The largest contributor to nonadherence was the number of referrals made; patients who were referred to multiple specialists were more likely to be nonadherent. Peer support services may lower barriers to follow-up.

Analysis of patients attitude to undergo urgent endoscopic procedures during COVID-19 outbreak in Italy.

We conducted a survey to investigate to what extent the fear of COVID-19 has influenced the patients decision to undergo or to cancel endoscopic procedures. We collected data from 847 patients from 13 centres. The main indication for endoscopy was anemia, followed by pain and unexplained weight loss. The percentage of not presenters progressively increased throughout the three weeks of study, from 15.1% at the beginning to 48.2% at the end. 37 (34.2%) upper GI endoscopies and 112 (56.3 %) colonoscopies showed an organic cause explaining the symptoms presented by the patients, respectively; 5 cases of gastric cancer (4.6%) and 16 cases of colorectal cancer (CRC) (6.0%), respectively, were detected; during the second week the percentage of organic diseases found at upper endoscopy was 19 (33.3%) with 5 cancer (8.7%), and 61 (49.1% ) at colonoscopy, with 2 CRC (1.6%); finally, during the third week the corresponding figures were 19 (48.7%) for upper GI examinations, with 3 gastric cancers (7.7%), and 43 (60.5%) with 4 (6.5%) CRC cases found.We conclude that patients weighted the fear of having a clinically relevant disease with the fear of becoming infected by coronavirus, and a relevant percentage of them (29.4%) decided not to attend the endoscopy suites at the scheduled date.

Did psychosocial status, sociodemographics and smoking status affect non-attendance in control participants in the Danish Lung Cancer Screening Trial? A nested observational study.

OBJECTIVES: We investigated if psychosocial status, sociodemographics and smoking status affected non-attendance in the control group in the randomised Danish Lung Cancer Screening Trial (DLCST). DESIGN AND SETTING: This study was an observational study nested in the DLCST. Due to large non-attendance in the control group in the second screening round we made an additional effort to collect questionnaire data from non-attenders in this group in the third screening round. We used a condition-specific questionnaire to assess psychosocial status. We analysed the differences in psychosocial status in the third and preceding rounds between non-attenders and attenders in the control group in multivariable linear regression models adjusted for sociodemographics and smoking status reported at baseline. Differences in sociodemographics and smoking status were analysed with χ2 tests (categorical variables) and t-tests (continuous variables). PRIMARY OUTCOME MEASURE: Primary outcome was psychosocial status. PARTICIPANTS: All control persons participating in the third screening round in the DLCST were included. RESULTS: Non-attenders in the third round had significantly worse psychosocial status than attenders in the scales: 'behaviour' 0.77 (99% CI 0.18 to 1.36), 'self-blame' 0.59 (99% CI 0.14 to 1.04), 'focus on airway symptoms' 0.22 (99% CI 0.08 to 0.36), 'stigmatisation' 0.51 (99% CI 0.16 to 0.86), 'introvert' 0.56 (99% CI 0.23 to 0.89) and 'harms of smoking' 0.35 (99% CI 0.11 to 0.59). Moreover, non-attenders had worse scores than attendees in the preceding screening rounds. Non-attenders also reported worse sociodemographics at baseline. CONCLUSIONS: Non-attenders had a significantly worse psychosocial status and worse sociodemographics compared with attenders. The results of our study contribute with evidence of non-response and attrition driven by psychosocial status, which in turn may be influenced by the screening intervention itself. This can be used to adjust cancer screening trial results for bias due to differential non-attendance. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov Protocol Registration System (NCT00496977).

Hearing aid review appointment: clients' reasons for attendance and non-attendance.

Objective: To investigate hearing aid owners' decisions to attend or not to attend an annual hearing aid review (HAR) appointment. To investigate the possible factors associated with appointment attendance, including age, gender, transportation, travel time, and hearing aid outcomes.Design: A prospective cohort study. Potential participants were notified of their annual HAR appointment in the usual process employed by their clinic. Two months later, potential participants were identified as those who had attended and those who had not attended an appointment.Study sample: One hundred and twenty adult hearing aid users ranging in age from 26 to 100 (M = 74, SD = 11) years recruited from a single hearing clinic in Perth, Western Australia.Results: Factors found to be significantly associated with attendance at an annual HAR appointment included hearing aid funding source (government subsidised), participants valuing the importance and benefit of the appointment, and superior hearing aid outcomes.Conclusions: Within a controlled practice setting, appointment attendance is influenced by some factors modifiable by the clinician, including providing better education about the process and purpose of the HAR appointment. The value of the HAR appointment was emphasised by the positive association between better hearing aid outcomes HAR appointment attendance.

Causes of appointment attendance, nonattendance, and cancellation in outpatient consultations at a university hospital.

BACKGROUND: Nonattendance to scheduled appointments in outpatient clinics is a frequent problem in ambulatory medicine with an impact on health systems and patients' health. The characterization of nonattendance is fundamental for the design of appropriate strategies for its management. AIMS: To identify causes of nonattendance of scheduled ambulatory medical appointments by adult patients. METHODS: Case and two controls study nested in a prospective cohort. A telephone-administered questionnaire was applied within the first 72 hours to identify the causes of attendance, nonattendance, or cancellation in patients who had a scheduled appointment to which they had been present, absent, or cancelled. RESULTS: A total of 150 absences (cases), 176 attendances, and 147 cancellations (controls) in a prospective cohort of 160 146 scheduled appointments (2012/2013) were included. According to self-reports in telephone interviews, the most frequent causes of nonattendance were forgetting 44% (66), unexpected competing events 15.3% (23), illness or unwellness 12% (18), work-related inconvenience 5.3% (8), transport-related difficulties 4.7% (4), and cause that motivated appointment scheduling already resolved 4.7% (4). DISCUSSION: The main cause of nonattendance is forgetting the scheduled appointment, but there is a proportion of different causes that do not respond to reminders but could respond to different strategies.

A mixed-methods exploration of non-attendance at diabetes appointments using peer researchers.

BACKGROUND: Non-attendance at diabetes appointments is costly to the health service and linked with poorer patient outcomes. OBJECTIVE: Peer researchers aimed to conduct interviews and survey people who miss appointments about their beliefs and perceptions regarding their diabetes and diabetes appointments. DESIGN: A mixed-methods cross-sectional design with interviews conducted by peer researchers with diabetes and a questionnaire was used. SETTING AND PARTICIPANTS: Peer researchers conducted semi-structured telephone interviews in one health board in Scotland with ten people who had missed diabetes appointments. A further 34 people who had missed appointments completed a questionnaire. The study was informed by two psychological theories (the Theory of Planned Behaviour and the Self-Regulation Model), and interviews were analysed using thematic analysis. RESULTS: Interviewees planned to attend appointments but practical barriers, low perceived value of appointments and the feeling that diabetes had little impact upon their lives' emerged as key reasons for missing appointments. Questionnaire data supported these findings and showed that respondents perceived diabetes to have only mildly serious consequence and cause limited concern and emotional impact. Participants' understanding of their condition and perceptions of personal control and treatment control were low. Gender, perceived behavioural control and emotional representations were significantly associated with the number of appointments missed in the previous year. CONCLUSIONS: These findings highlight the importance of psychological variables in predicting non-attendance at diabetes appointments and provide avenues for how non-attendance might be tackled.

Winter cancellations of elective surgical procedures in the UK: a questionnaire survey of patients on the economic and psychological impact.

OBJECTIVES: To quantify the economic and psychological impact of the cancellation of operations due to winter pressures on patients, their families and the economy. DESIGN: This questionnaire study was designed with the help of patient groups. Data were collected on the economic and financial burden of cancellations. Emotions were also quantified on a 5-point Likert scale. SETTING: Five NHS Hospital Trusts in the East Midlands region of England. PARTICIPANTS: We identified 796 participants who had their elective operations cancelled between 1 November 2017 and 31 March 2018 and received responses from 339 (43%) participants. INTERVENTIONS: Participants were posted a modified version of a validated quality of life questionnaire with a prepaid return envelope. MAIN OUTCOME MEASURES: The primary outcome measures were the financial and psychological impact of the cancellation of elective surgery on patients and their families. RESULTS: Of the 339 respondents, 163 (48%) were aged <65 years, with 111 (68%) being in employment. Sixty-six (19%) participants had their operations cancelled on the day. Only 69 (62%) of working adults were able to return to work during the time scheduled for their operation, with a mean loss of 5 working days (SD 10). Additional working days were lost subsequently by 60 (54%) participants (mean 7 days (SD 10)). Family members of 111 (33%) participants required additional time off work (mean 5 days (SD 7)). Over 30% of participants reported extreme levels of sadness, disappointment, anger, frustration and stress. At least moderate concern about continued symptoms was reported by 234 (70%) participants, and 193 (59%) participants reported at least moderate concern about their deteriorating condition. CONCLUSIONS: The cancellation of elective surgery during the winter had an adverse impact on patients and the economy, including days of work lost and health-related anxiety. We recommend better planning, and provision of more notice and better support to patients.

Estimating willingness-to-pay for health care: A discrete choice experiment accounting for non-attendance to the cost attribute.

RATIONALE, AIMS, AND OBJECTIVES: The literature suggests that discrete choice experiments (DCEs) are a preferable method for estimating willingness-to-pay (WTP) values, as they may avoid some biases often observed in contingent valuation surveys, such as protest and strategic behaviour. However, the choice studies have demonstrated that attribute non-attendance may be a serious issue that leads to biased WTP estimates. METHOD: A DCE was used to estimate patients' WTP for dental care at the dental school clinic. The endogenous attribute attendance (EAA) model was used to estimate WTP for dental care attributes, while accounting for non-attendance to the cost attribute. RESULTS: The EAA model revealed that almost every second respondent had ignored the cost attribute when making choices, indicating that patients were very sensitive to other characteristics of dental care. Dental care providers should pay particular attention to providing a detailed explanation of treatment to their patients, as this was the most valued attribute of dental care. The welfare estimates from the EAA model, which accounted for non-attendance to the cost attribute, were more than two times lower than welfare estimates from a traditional multinomial logit model and mixed logit model estimated in WTP space. CONCLUSIONS: The findings raise concerns for derived WTP estimates in DCE studies that did not consider non-attendance to the cost attribute during the estimation process. Non-attendance to the cost attribute overestimates WTP values, even if being motivated by the true preferences of respondents.

Non-attendance in a secondary paediatric referral centre.

INTRODUCTION: Non-attendance in outpatient clinics may be associated with risks to patients' health, disturb the management of clinics and cause a waste of healthcare resources. The aim of the present study was to measure the non-attendance rate in a secondary paediatric outpatient centre and to assess reasons for non-attendance. METHODS: Non-attendance in children and adolescents aged 0-19 years were recorded prospectively during a year. In a telephone interview, the families of non-attending patients were asked about their reasons for non-attending. RESULTS: The number of scheduled attendances in 1,466 patients was 4,566. A total of 196 non-attendances (4.3%) were recorded in 167 patients (11.4%); 129 were boys (77.2%), 38 girls (22.8%). Patients aged 10-19 years had a higher frequency of non-attendance than patients in the 0-9-year age group (16% (115/715) versus 7% (52/751), respectively, p < 0.001). A total of 110 families (65.9%) stated that the reason for their non-attendance was that they had forgotten the appointment; 19 (11.4%) said that the family had decided not to show up because they had considered that their child had recovered. CONCLUSIONS: The non-attendance rate in the secondary paediatric referral centre studied was low. The majority of non-attendance may be explained by forgetfulness. FUNDING: none. TRIAL REGISTRATION: not relevant.

Reasons For Lack of Follow-up Colonoscopy Among Persons With A Positive Fecal Occult Blood Test Result: A Qualitative Study.

OBJECTIVES: Follow-up colonoscopy rates among persons with positive fecal occult blood test results (FOBT + ) remain suboptimal in many jurisdictions. In Ontario, Canada, primary care providers (PCPs) are responsible for arranging follow-up colonoscopies. The objectives were to understand the reasons for a lack of follow-up colonoscopy and any action plans to address follow-up. METHODS: Semi-structured interviews were conducted with 30 FOBT+ persons and 30 PCPs in Ontario. Eligible FOBT+ persons were identified through administrative databases and included those aged 50-74, with a 6-12 month old FOBT+, no follow-up colonoscopy, and no prior colorectal cancer diagnosis or colectomy. Eligible PCPs had ≥1 rostered FOBT+ person without follow-up colonoscopy. Transcripts were analyzed inductively using Nvivo 11 (QSR International Pty Ltd., 2015). RESULTS: Reasons for lack of follow-up colonoscopy were: person and/or provider believed the FOBT + was a false positive; person was afraid of colonoscopy; person had other health issues; and breakdown in communication of FOBT+ results or colonoscopy appointments. PCPs who initially recommended follow-up colonoscopy did not change the minds of the persons who dismissed the FOBT+ as a false positive and/or who were afraid of the procedure. These FOBT+ persons negotiated an alternative follow-up action plan including repeating the FOBT or not following-up. CONCLUSIONS: PCPs may not adequately counsel FOBT+ persons who believe the FOBT+ is a false positive and/or fear colonoscopy. PCPs may lack fail-safe systems to communicate FOBT+ results and colonoscopy appointments. Using navigators may help address these barriers and increase follow-up rates.

Understanding Why Patients No-Show: Observations of 2.9 Million Outpatient Imaging Visits Over 16 Years.

PURPOSE: To understand why patients "no-show" for imaging appointments, and to provide new insights for improving resource utilization. MATERIALS AND METHODS: We conducted a retrospective analysis of nearly 2.9 million outpatient examinations in our radiology information system from 2000 to 2015 at our multihospital academic institution. No-show visits were identified by the "reason code" entry "NOSHOW" in our radiology information system. We restricted data to radiography, CT, mammography, MRI, ultrasound, and nuclear medicine examinations that included all studied variables. These variables included modality, patient age, appointment time, day of week, and scheduling lead time. Multivariate logistic regression was used to identify factors associated with no-show visits. RESULTS: Out of 2,893,626 patient visits that met our inclusion criteria, there were 94,096 no-shows during the 16-year period. Rates of no-show visits varied from 3.36% in 2000 to 2.26% in 2015. The effect size for no-shows was strongest for modality and scheduling lead time. Mammography had the highest modality no-show visit rate of 6.99% (odds ratio [OR] 5.38, P < .001) compared with the lowest modality rate of 1.25% in radiography. Scheduling lead time greater than 6 months was associated with more no-show visits than scheduling within 1 week (OR 3.18, P < .001). Patients 60 years and older were less likely to miss imaging appointments than patients under 40 (OR 0.70, P < .001). Mondays and Saturdays had significantly higher rates of no-show than Sundays (OR 1.52 and 1.51, P < .001). CONCLUSION: Modality type and scheduling lead time were the most predictive factors of no-show. This may be used to guide new interventions such as targeted reminders and flexible scheduling.

Flexible Sigmoidoscopy and CT Colonography Screening: Patients' Experience with and Factors for Undergoing Screening-Insight from the Proteus Colon Trial.

Purpose To compare the acceptability of computed tomographic (CT) colonography and flexible sigmoidoscopy (FS) screening and the factors predicting CT colonographic screening participation, targeting participants in a randomized screening trial. Materials and Methods Eligible individuals aged 58 years (n = 1984) living in Turin, Italy, were randomly assigned to be invited to screening for colorectal cancer with FS or CT colonography. After individuals who had died or moved away (n = 28) were excluded, 264 of 976 (27.0%) underwent screening with FS and 298 of 980 (30.4%) underwent CT colonography. All attendees and a sample of CT colonography nonattendees (n = 299) were contacted for a telephone interview 3-6 months after invitation for screening, and screening experience and factors affecting participation were investigated. Odds ratios (ORs) were computed by means of multivariable logistic regression. Results For the telephone interviews, 239 of 264 (90.6%) FS attendees, 237 of 298 (79.5%) CT colonography attendees, and 182 of 299 (60.9%) CT colonography nonattendees responded. The percentage of attendees who would recommend the test to friends or relatives was 99.1% among FS and 93.3% among CT colonography attendees. Discomfort associated with bowel preparation was higher among CT colonography than FS attendees (OR, 2.77; 95% confidence interval [CI]: 1.47, 5.24). CT colonography nonattendees were less likely to be men (OR, 0.36; 95% CI: 0.18, 0.71), retired (OR, 0.31; 95% CI: 0.13, 0.75), to report regular physical activity (OR, 0.37; 95% CI: 0.20, 0.70), or to have read the information leaflet (OR, 0.18; 95% CI: 0.08, 0.41). They were more likely to mention screening-related anxiety (mild: OR, 6.30; 95% CI: 2.48, 15.97; moderate or severe: OR, 3.63; 95% CI: 1.87, 7.04), erroneous beliefs about screening (OR, 32.15; 95% CI: 6.26, 165.19), or having undergone a recent fecal occult blood test (OR, 13.69; 95% CI: 3.66, 51.29). Conclusion CT colonography and FS screening are well accepted, but further reducing the discomfort from bowel preparation may increase CT colonography screening acceptability. Negative attitudes, erroneous beliefs about screening, and organizational barriers are limiting screening uptake; all these factors are modifiable and therefore potentially susceptible to interventions. © RSNA, 2017 Online supplemental material is available for this article.

Sexual health clinic attendance and non-attendance in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).

OBJECTIVES: In Britain, sexual health clinics (SHCs) are the most common location for STI diagnosis but many people with STI risk behaviours do not attend. We estimate prevalence of SHC attendance and how this varies by sociodemographic and behavioural factors (including unsafe sex) and describe hypothetical service preferences for those reporting unsafe sex. METHODS: Complex survey analyses of data from Britain's third National Survey of Sexual Attitudes and Lifestyles, a probability survey of 15 162 people aged 16-74 years, undertaken 2010-2012. RESULTS: Overall, recent attendance (past year) was highest among those aged 16-24 years (16.6% men, 22.4% women), decreasing with age (<1.5% among those 45-74 years). Approximately 15% of sexually-active 16-74 year olds (n=1002 men; n=1253 women) reported 'unsafe sex' (condomless first sex with a new partner and/or ≥2 partners and no condom use, past year); >75% of these had not attended a SHC (past year). However, of non-attenders aged 16-44 years, 18.7% of men and 39.0% of women reported chlamydia testing (past year) with testing highest in women aged <25 years. Of those aged 16-44 years reporting unsafe sex, the majority who reported previous SHC attendance would seek STI care there, whereas the majority who had not would use general practice. CONCLUSION: While most reporting unsafe sex had not attended a SHC, many, particularly younger women, had tested for chlamydia suggesting engagement with sexual health services more broadly. Effective, diverse service provision is needed to engage those at-risk and ensure that they can attend services appropriate to their needs.