TY - JOUR
T1 - Management of Small Polyps Detected by Screening CT Colonography
T2 - Patient and Physician Preferences
AU - Shah, Jessica P.
AU - Hynan, Linda S.
AU - Rockey, Don C.
N1 - Funding Information:
Funding: Dr Shah was supported in part by a National Institutes of Health research grant (NIH T32-DK07745).
PY - 2009/7
Y1 - 2009/7
N2 - Background: Management of small polyps found on computed tomography (CT) colonography is controversial and critical to both cancer outcomes and cost. Patient and physician behavior are influenced by personal beliefs and prior experience. Thus, we aimed to understand patient and physician preferences after finding polyps on CT colonography. Methods: Patients were given a validated handout and survey asking for their preference for evaluation of a "pea-sized" polyp found on CT colonography. By using an Internet survey, physicians were asked how they would manage a 5-mm, 8-mm, or 12-mm polyp, or three 5-mm polyps found by CT colonography in a hypothetical 52-year-old patient of average colorectal cancer risk. Survey reliability was assessed using Cronbach's coefficient alpha. Results: Of the 305 patient respondents, 95% wanted to know if the polyp found on CT colonography was precancerous, 86% stated they would request endoscopic evaluation, and 85% wanted polypectomy. Of the 277 primary care physicians, 71% would refer a 5-mm sigmoid polyp for endoscopy, 86% would refer an 8-mm polyp, 97% would refer a 12-mm polyp, and 91% would refer three 5-mm polyps. Of the 461 gastroenterologists, 83% would refer a 5-mm sigmoid polyp for endoscopy, 96% would refer an 8-mm polyp, 97% would refer a 12-mm polyp, and 93% would refer three 5-mm polyps. Overall, 75% of physicians indicated the fear of missing a precancerous lesion would prompt referral for colonoscopy. Conclusion: Both patients and physicians overwhelmingly preferred to follow up small polyps identified by CT colonography with endoscopy, suggesting that population-based CT colonography screening programs in which polyps are not removed might require significant patient and physician education before implementation.
AB - Background: Management of small polyps found on computed tomography (CT) colonography is controversial and critical to both cancer outcomes and cost. Patient and physician behavior are influenced by personal beliefs and prior experience. Thus, we aimed to understand patient and physician preferences after finding polyps on CT colonography. Methods: Patients were given a validated handout and survey asking for their preference for evaluation of a "pea-sized" polyp found on CT colonography. By using an Internet survey, physicians were asked how they would manage a 5-mm, 8-mm, or 12-mm polyp, or three 5-mm polyps found by CT colonography in a hypothetical 52-year-old patient of average colorectal cancer risk. Survey reliability was assessed using Cronbach's coefficient alpha. Results: Of the 305 patient respondents, 95% wanted to know if the polyp found on CT colonography was precancerous, 86% stated they would request endoscopic evaluation, and 85% wanted polypectomy. Of the 277 primary care physicians, 71% would refer a 5-mm sigmoid polyp for endoscopy, 86% would refer an 8-mm polyp, 97% would refer a 12-mm polyp, and 91% would refer three 5-mm polyps. Of the 461 gastroenterologists, 83% would refer a 5-mm sigmoid polyp for endoscopy, 96% would refer an 8-mm polyp, 97% would refer a 12-mm polyp, and 93% would refer three 5-mm polyps. Overall, 75% of physicians indicated the fear of missing a precancerous lesion would prompt referral for colonoscopy. Conclusion: Both patients and physicians overwhelmingly preferred to follow up small polyps identified by CT colonography with endoscopy, suggesting that population-based CT colonography screening programs in which polyps are not removed might require significant patient and physician education before implementation.
KW - Adenoma
KW - Colonoscopy
KW - Virtual colonoscopy
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U2 - 10.1016/j.amjmed.2009.01.028
DO - 10.1016/j.amjmed.2009.01.028
M3 - Article
C2 - 19559172
AN - SCOPUS:67649803359
SN - 0002-9343
VL - 122
SP - 687.e1-687.e9
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 7
ER -