1. A Quality improvement initiative
UMass Memorial Medical Center. Dept of Medicine-Worcester, MA, United States.
Analysis of the knowledge, attitudes and practices of patients in the ambulatory care setting with regards to colonoscopy and assessment of educational aids in reducing the rates of refusal of first-time screening colonoscopy:
A Quality improvement initiative
Soumil Patwardhan MD, Erik Holzwanger MD, Lidia Spaho MD, Christopher Marshall MD.
Background
Figures
Results
Symptoms concerning for or suspicious of colon cancer (over past 1 year) (%)
Present 32
Absent 68
Family History of colon cancer (%) 10 89
Unknown 1
Colonoscopy in the family (%)
Yes 27 No 66 7
Family experience of colonoscopy, if applicable (%)
Less than desirable 9
As expected 23
Better than expected 61
Information received about colonoscopy from? (%)
PCP 73
Family 31
Friends 26
Social Media/Internet
Television 13
Alternative tests (FITT/Sigmoidoscopy) done ? (%)
Colorectal cancer (CRC) is the 2nd leading cause of death from cancer in the United States.
CRC screening detects cancers at an earlier and curable stage resulting in reduction of mortality. It also detects precursor lesions, reducing incidence of colorectal cancer.
Sensitivity of screening colonoscopy is % for advanced adenoma and >95% for CRC.
Screening colonoscopy at 50 years of age is recommended by the USPSTF (Grade A) and the ACG (Grade 1B).
In spite of repeated counseling, many patients in our primary care clinics continue to refuse screening colonoscopy.
A quality improvement study was hence initiated at our center:
to identify reasons for refusal of screening colonoscopy AND
to assess if educational aids would help reduce the refusal rate of first-time screening colonoscopy.
Over a three month period, 89 patients participated in this study.
Mean age of the participants was 56 years and 63% were males. Mean Body Mass Index was (slightly overweight). 72% were Caucasians and around 48% were married.
The acceptance rate of screening colonoscopy was 69% (Figure 1).
Out of 28 patients that refused, only 11% (3/28) agreed to a colonoscopy after reading the educational aid. (Figure 2)
Using logistic regression analysis, subgroup analysis was performed to identify factors influencing rates of acceptance.
Factors that were significantly associated with a higher rate of colonoscopy acceptance included age < 53 years (p = 0.025), history of symptoms concerning for colon cancer (p = 0.011) and hearing about a colonoscopy from their primary care physician or a family member (p = and respectively).
Factors significantly associated with a higher rate of refusal included having a family history of colon cancer (p = 0.01), dislike of colonoscopy (p = 0.1) and hearing or reading about colonoscopy in social media (p = 0.066).
Methods
Patients >= 50 years of age, due for a first time screening colonoscopy
Patients asked if they would like to undergo a screening colonoscopy
Survey 1 administered (Table 1)
Conclusions
Responses recorded and patient is removed from the study’
Table 1
Patient says ‘Yes’
Patient says ‘No’
Simply providing self-read educational aids have little impact in reducing the refusal rate for screening colonoscopy in our clinic population.
Primary care physicians had the highest impact in improving the acceptance rates of screening colonoscopy, whereas the fear about having colorectal cancer due to a positive family history had the highest impact in patients refusing one.
Future educational aids need to address these patient-specific concerns to improve the overall rates of acceptance of screening colonoscopy. Further studies are needed to assess the utility of other types of educational aids like audio-visual clips or personal counselors work with primary care doctors.
Colonoscopy educational brochure given to patient
Patients asked if they would like to undergo screening colonoscopy
Survey 2 administered
Subgroup analysis performed to identify factors influencing rates of acceptance
Percentage of patients who initially said ‘No’ and now have said ‘Yes’ after the brochure (Primary Outcome)
Patients’ responses, either ‘Yes’ or ‘No’, are recorded
Figure 2