Original article—alimentary tract
Awareness of Surveillance Recommendations Among Patients With Colorectal Adenomas

https://doi.org/10.1016/j.cgh.2011.11.022Get rights and content

Background & Aims

The efficacy of colorectal cancer screening programs depends on the rate of attendance at surveillance colonoscopy examinations. Increasing patients' awareness about the importance of surveillance might improve attendance, but it is not clear how much they know about their follow-up recommendations. We assessed the awareness of patients with adenomas about their surveillance recommendations.

Methods

Ten endoscopy departments provided access to their colonoscopy database for quality assurance; 2 datasets were obtained. We analyzed data from 4000 colonoscopies (400 per department) performed on patients with adenomas. All the patients were mailed a survey to determine how much information they had about their colonoscopy results and their follow-up recommendations. Data from 549 patients were included in the analysis. We also assessed surveillance attendance among 500 patients (50 per department) who had adenomas removed.

Results

Of the patients analyzed, 85% recalled retrieval of polyps during their colonoscopy, and 85% recalled whether they needed surveillance or not. The indication for surveillance was recalled by 69% of patients (range between departments, 55%–83%; P < .01). Factors that were associated with awareness of recommendations were younger age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.06–1.09), treatment by a gastroenterologist (OR, 5.53; 95% CI, 3.28–9.32), and presence of 3 or more adenomas (OR, 2.97; 95% CI, 1.29–6.85). Attendance among patients with adenomas varied among departments, from 60% to 89% (P < .01), and was not associated with awareness of patients about their recommendations per department (P = .59).

Conclusions

Not enough patients (only 85%) who receive colonoscopies are aware of their results or surveillance recommendations. Although awareness of findings and recommendations did not correlate with follow-up attendance, patients should be better informed about findings and their need for surveillance.

Section snippets

Methods

A patient survey was used for this study. Survey items were selected using discussion with experts in the endoscopy field, after determination of the measurement aim and target population as previously recommended for designing surveys.11 The survey contained questions evaluating the information and (histologic) findings at initial colonoscopy, the knowledge of follow-up recommendations, and knowledge about reasons why follow-up evaluation was or was not recommended. In addition, we assessed

Results

Among the 4000 cases in data set 1, 798 (20%) patients with at least one adenoma were identified for inclusion. Patients were excluded for the survey mailing rounds if they had died (n = 28), or if their contact details could not be retrieved (n = 32). The remaining 738 patients were approached by mail (Figure 1).

A total of 604 of 738 patients responded (82%). A total of 55 surveys were withdrawn from the analyses because of incomplete answers, leading to 549 analyzable surveys. The mean time

Discussion

Patients who have undergone endoscopic adenoma removal are at increased risk for adenoma recurrence.14 Surveillance colonoscopy in adenoma-bearing patients therefore is acknowledged as a key aspect of CRC prevention.14 Embedded in the effectiveness of CRC screening, the attendance rate for surveillance colonoscopy is of utmost importance.7, 15, 16 Patient attendance may be influenced by patient awareness of their own colonoscopy findings and knowledge about the necessity for surveillance. Our

Acknowledgments

SCoPE Consortium participants: J. Sint Nicolaas, V. de Jonge, M. E. van Leerdam, and E. J. Kuipers (Erasmus MC University Medical Center, Rotterdam, The Netherlands); F. ter Borg (Deventer Hospital, Deventer, The Netherlands); J. T. Brouwer (Reinier de Graaf Hospital, Delft, The Netherlands); D. L. Cahen (Amstelland Hospital, Amstelveen, The Netherlands); F. J. G. M. Kubben (Maasstad Hospital, Rotterdam, The Netherlands); W. Lesterhuis (Albert Schweitzer Hospital, Dordrecht, The Netherlands);

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    Conflicts of interest The authors disclose no conflicts.

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