Perception of Colonoscopy Benefits: A Gap in Patient Knowledge?
Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, NH, USA.Journal of Community Health (Impact Factor: 1.28). 11/2011; 37(3):719-24. DOI: 10.1007/s10900-011-9506-z
Our study aimed to determine, for patients who had undergone recent colonoscopy, associations between specific colonoscopy patient characteristics, exam characteristics and patients' perception of colonoscopy reducing their risk of dying from colorectal cancer. A cross-sectional analysis was conducted using data (2004-2008) from the New Hampshire Colonoscopy Registry, consisting of a Self-report Questionnaire, Colonoscopy Report form, and a Follow-up Questionnaire, which measured agreement responses to the statement, "Having a colonoscopy decreased my chances of dying from colon cancer". Chi-square tests and logistic regression were used to assess differences in patient responses by patient and colonoscopy characteristics. A majority of patients (N=5,672, 81%) agreed that having a colonoscopy decreased their chances of dying from colon cancer. Patients with a personal history of polyps were more likely to agree that colonoscopy reduced their chances of dying compared to patients without prior polypectomy [OR (95% CI) =1.34 (1.06, 1.69)] and patients with a family history of colorectal cancer were 33% more likely to agree to the statement than those without a family history [OR (95% CI) =1.33 (1.12, 1.58)]. Personal history of polyps and family history of colorectal cancer are significant predictors of patients' positive perception of colonoscopy, suggesting that personal experience, rather than the potential preventive effect of colonoscopy itself, may influence the perceived benefit of colonoscopy. Intervention efforts should be made to effectively disseminate knowledge of the preventive benefit of colonoscopy.
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ABSTRACT: To determine perceived risks and benefits of colonoscopy surveillance among patients undergoing surveillance colonoscopy due to family history of colorectal cancer (CRC). We conducted a standardised phone interview of 250 randomly selected people who had undergone surveillance colonoscopy at Dunedin Hospital. We assessed perceptions of colonoscopy effectiveness, complication rates, and CRC risk. We included 148 (69%) participants. Most felt well informed about surveillance (66.7%), but many wanted further information (63.2%). Most accurately estimated complication rates (discomfort: Common/Uncommon 70.3%; pain: Rare/Uncommon 58.8%; bleeding: Rare/Uncommon 72.3%; perforation: Very rare 62.8%), and benefits (mean reduction in risk of CRC 72.6% and death 76.2%). Most (55.1%) over-estimated their CRC risk. 13.5% thought perforation never occurred, and 12.8% thought colonoscopy either completely prevented, or had no effect on risk of developing or dying from CRC. Patients giving unrealistic estimates had similar demographics and clinical variables to the wider cohort. Our results suggest current surveillance education adequately communicates risks and benefits to most patients. A minority have unrealistic views and further education may be indicated.
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ABSTRACT: Colorectal cancer (CRC) is the third leading cause of cancer death in the United States, and is largely preventable by CRC screening (CRCS). Participation in CRCS, however, is much lower than participation in other forms of preventive care. Many reasons for low rates of participation have been identified, and can be generally divided into provider- and patient-specific issues. Lack of a provider recommendation is a well-established and widely reported patient barrier to CRCS. Numerous patient-specific issues have been identified, ranging from fear of CRCS test results to lack of knowledge about individual risk for CRC and inadequate resources to complete CRCS. This article discusses the impact of patient attitudes and issues toward CRCS, with particular attention to modifiable psychosocial factors, the importance of patient preferences for one CRCS test over another, knowledge of CRC risk, and the impact of educational tools on patient compliance with CRCS.
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