Introduction The BSG advocates discussion with patients regarding surveillance colonoscopy for chronic inflammatory bowel disease (IBD). The 2009 IBD standards document, which carries support from multidisciplinary organisations as well as patient groups, recommends clear, written information for patients. We have not previously provided this for patients prior to surveillance colonoscopy.
Methods We prospectively audited understanding of the surveillance colonoscopy programme in patients with a diagnosis of extensive colonic IBD for >8 years. A questionnaire was conducted by a single interviewer in clinic or by telephone to determine knowledge of colorectal cancer (CRC) risk, significance of dysplasia and potential clinical advice should dysplasia be identified. An information leaflet was written and sent to a cohort of patients who subsequently had surveillance colonoscopy in the study period and their knowledge was reassessed.
Result 55 patients were recruited. 71% identified an increased risk of CRC. 22% recognised that surveillance was undertaken to assess for dysplasia/pre-cancerous changes (44% stated, “check up”, 25% responded, “check for cancer” and 9% answered, “check for flare”). 11% identified that colectomy would be advised if dysplasia was found (31% stated, “remove affected part”, 18% responed, “medications” and 40% answered, “don't know”).
16/55 patients received an information leaflet prior to surveillance colonoscopy and were re-interviewed on the day of their procedure. 88% understood the dysplasia concept and 75% understood that colectomy would usually be advised if significant dysplasia was identified.
Conclusion Patient knowledge regarding CRC screening in IBD is poor but is significantly improved following the supply of written information. By improving knowledge of the indication for the procedure, the validity of consent is optimised. IBD standards allow patients to demand quality information and we now supply patients with an information leaflet at the time of discussion in clinic and with colonoscopy appointment letters and have scheduled to re-audit in 1 year.
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