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

Abstract

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 morbidityand increases the survival rates, non-attendance of gastroenterology (GI) endoscopic procedures is a significant globalproblem, which can lead to delay in cancer diagnosis and treatment. Several factors have been found to contribute tonon-attendance behavior, including socioeconomic, cultural, and organizational related barriers. The purpose of thisstudy was to identify factors contributing to non-attendance behavior among outpatients scheduled for GI endoscopicprocedures in a tertiary hospital in the United Arab Emirates. We conclude with recommendations that can help inreducing the rate of patient no-shows for GI endoscopic procedures in the region. Methods: In a tertiary medical centerin the Middle East, we surveyed patients who did not attend their scheduled GI endoscopic procedures over a periodof one year. The questionnaire sought to identify possible reasons for patient’s non-attendance. Descriptive measuresincluding means, standard deviation, frequencies, and percentages were used to analyze the demographic characteristicsof the study participants. The chi-square test was performed to analyze gender differences. Results: Of 314 outpatientswho met study inclusion criteria, 168 agreed to participate (53.5% response rate). The majority of participants werewomen (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 colonoscopyand upper endoscopy (36.3 %), colonoscopy alone (31.3 %), or upper endoscopy alone (31.3 %). The most commoncauses for cancellation or non-attendance included concerns about the appointment (35.5%), inconvenient timing ofthe appointment (27.9%) and changes in medical status (26.4%). Gender differences were noted for non-attendancebehaviors, 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 wellas opportunities to reduce the rate of patient no-shows, including patient education, scheduling options, and protocolsto minimize discomfort and misconceptions around GI endoscopic procedures, particularly accommodating for samegender endoscopists, with the ultimate goal of increasing early cancer screening and prevention