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PATIENT AND PHYSICIAN PERCEPTIONS OF THE INDICATION FOR COLONOSCOPY
MJ Sewitch, C Fournier, R Hilsden
PURPOSE: Colorectal cancer (CRC) screening is becoming a priority in preventive medicine. However, little is know about the extent to which patients and their treating endoscopists agree on the indication for colonoscopy (screening vs. non-screening).
METHODS: Montreal and Calgary university-affiliated hospital staff endoscopists and their patients (aged 50-75 years, scheduled to undergo colonoscopy) were invited to participate. Prior to colonoscopy, patients completed an interviewer-administered questionnaire assessing their perceptions of the indication for colonoscopy. Following colonoscopy, endoscopists completed a self-administered questionnaire assessing their perceptions of the indication for colonoscopy. Colonoscopy indications were classified as: (1) screening (regular screening, age, CRC family history) and (2) non-screening (CRC, colon polyps, inflammatory bowel disease, follow-up to a positive screen, gastrointestinal symptoms, other).
RESULT: A total of 1,241 eligible patients (701 Montreal; 540 Calgary) and 75 endoscopists (38 Montreal; 37 Calgary) participated (January-March 2007). Overall, 577 (46%) patients reported undergoing screening colonoscopies (329 Montreal; 248 Calgary) and endoscopists reported performing 583 (47%) screening colonoscopies (352 Montreal; 231 Calgary). Patients and physicians agreed in 1,045 (84%) of colonoscopies (603 Montreal; 442 Calgary). Using the endoscopist indication as the gold standard, the sensitivity and specificity of patient report of a screening colonoscopy were 83.1% and 88.9%, respectively for Montreal and 82.6% and 81.2%, respectively for Calgary. Kappa was 0.72 for Montreal and 0.63 for Calgary.
CONCLUSION: The indication for colonoscopy was concordant in 84% of cases. Using a detailed patient questionnaire may be practical for documenting the indication for colonoscopy. However, investigators and clinicians should be aware that, on average, 16% of cases may be misclassified.