• Steven J Atlas, Katherine L Gallagher, Sydney E McGovern, Amy J Wint, Rebecca E Smith, David G Aman, Wenyan Zhao, Timothy E Burdick, E John Orav, Li Zhou, Adam Wright, TostesonAnna N AANAThe Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Hanover, NH, USA.Department of Community and Family Medicine, Dartmouth Health, Lebanon, NH, USA.Dartmouth Cancer Center, Dartmouth Health and G, and Jennifer S Haas.
• Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA. satlas@mgh.harvard.edu.
• J Gen Intern Med. 2024 Oct 18.

BackgroundTimely follow-up after an abnormal cancer screening test result is needed to maximize the benefits of screening, but is frequently not achieved. Little is known about patient experiences with the process of following up abnormal screening results.ObjectiveAssess patient experiences and perceptions regarding the process of a diagnostic workup following abnormal breast, cervical, or colorectal cancer screening results.DesignSurvey of participating patients between April 2021 and June 2022 after reaching the primary outcome time point in a randomized controlled trial to improve follow-up of overdue abnormal screening results.ParticipantsPatients from 44 participating practices in three primary care practice networks.Main MeasuresSelf-reported ease of scheduling follow-up, perceived barriers or concerns, provider trust, and satisfaction with communication and care received for the follow-up of abnormal screening results.ResultsOverall, 241 (25.0%) patients completed the survey including 66 (32.8%) with breast, 79 (25.3%) with cervical, and 96 (21.3%) with colorectal screening test; median age 55 years, 79.7% women, 80.5% non-Hispanic white, and 51.0% did not complete recommended follow-up. Most patients were worried that the test would find cancer (63.1%), but fewer worried about discomfort or side effects (34.4%), and neither were associated with completing follow-up. However, 17% of patients did not think they needed follow-up tests or appointments and were less likely to complete follow-up (10.5% vs. 24.0%, respectively, p-value 0.009). Most patients were very satisfied with their overall care (71.0%), but only 50.2% strongly agreed that they trusted their provider to put their medical needs above all else when making recommendations.ConclusionsPatients with overdue abnormal breast, cervical, and colorectal cancer screening test results reported important deficiencies in the management of recommended follow-up. Addressing patient concerns about fear of cancer and effectively communicating the need for follow-up procedures may improve timely follow-up after an abnormal cancer screening result.Trial RegistrationClinicalTrials.gov NCT03979495.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

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