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by Melissa Fray

Do your patients cringe when you suggest a routine colonoscopy? You are not alone – this is a common perception of colonoscopy, as many gastroenterologists see their patients clench up at the mere thought of the procedure.

Colonoscopy is an important screening test for colorectal cancer, of course, but a large percentage of patients skip the procedure. In fact, the Centers for Disease Control and Prevention (CDC) says that about one in three adults aged 50 to 75 had not undergone any type of colorectal cancer testing as recommended by the United States Preventive Services Task Force (USPSTF).

Negative attitudes about colonoscopy may contribute to non-attendance; worse still, negative perceptions about this important screening test may ultimately prevent patients from getting the care they need during the early stages of colorectal cancer, while it is still most treatable.

Barriers to colorectal screening include patients’ embarrassment about the procedure, anxiety over the prep, concerns about complications, and even fear about learning that they have cancer. Fortunately, you can take steps to improve public perception of colonoscopy.

7 Ways You Can Help to Improve the Perception of Colonoscopy:

  1. Leverage your relationships with referring physicians

Establish and maintain relationships with the primary care physicians who refer patients to your gastroenterology practice. The way your referring physicians frame the conversation can have a significant effect on patients’ attitudes towards the procedure. For example, researchers performed a survey of 2,500 colonoscopy-naïve respondents and 500 colonoscopy-experienced patients in France, Germany, Italy, Spain, and the UK. The results of the study, published in PLOS, found that 72 percent of colonoscopy-naïve respondents were receptive to colonoscopy upon the advice of their doctor. Unfortunately, only 45 percent of the patients surveyed understood its use to prevent colorectal cancer.

  1. Assess each patient’s perception of colonoscopy

Only 45 percent of respondents to the survey published in PLOS understood colonoscopy’s use to prevent colorectal cancer. An analysis of data from the New Hampshire Colonoscopy Registry found that 81 percent of responding patients knew that colonoscopy decreased their chances of dying from colon cancer. Those who had polyps in the past were more likely to agree that colonoscopy reduced their chances of dying than were those without prior polypectomy. Patients with a family history of colorectal cancer were 33 percent more likely to agree with that statement.

  1. Provide information about colonoscopy

Much of the perception about colonoscopy is rooted in misinformation or misconceptions about the procedure, its prep, and its potential for complications. Provide patients with colonoscopy information through blogs, white papers, and even videos via your practice website, through pamphlets readily available in the waiting room, colorful information sheets on the examination room walls, and through conversation. Offer information on how colonoscopy is superior to other colon cancer screening options.

  1. Address embarrassment head on

In the PLOS study, 43 percent of colonoscopy-experienced respondents said they would be embarrassed about having another colonoscopy; 59 percent said that the experience was better than they had expected.

A little assurance can go a long way when it comes to reducing embarrassment. Simply reminding a patient that a gastroenterologist performs dozens – if not hundreds – of colonoscopies a year can help, as can reassurance that the GI team will do everything possible to ensure that each patient will receive the most private, respectful, and modest care possible. Some patients may be less embarrassed about undergoing colonoscopy if they can choose whether to have a male or female gastroenterologist perform the procedure.

  1. Consider a lower-volume prep or split-dosing

Many people dread the prep more than they fear the colonoscop. This trepidation can prevent patients from scheduling a colonoscopy. Aversion to the prep is stronger in colonoscopy-experienced patients than in colonoscopy-naïve ones. According to the PLOS survey, it is 47 versus 26 percent.

Anxiety can also prevent patients from doing the prep properly. In fact, patients in 21 percent of colonoscopies in clinical studies had inadequate bowel preparation that made it difficult to visualize polyps smaller than 5 mm in size; it can also increase procedure time, lower polyp and flat lesion detection, decrease cecal intubation rates, and create an inefficient use of resources.

Surprisingly, it isn’t the bowel movements that put patients off – it is the amount of liquid they need to drink. An overwhelming 67 percent of colonoscopy-naïve respondents to the PLOS survey thought that one liter or less of bowel preparation should be required.

Consider using one of the new lower-volume preps or split dosing. Patients may be more amenable to these easier-to-take preps, and research shows split dosing significantly improved bowel cleansing, particularly in the right colon; other research shows low-volume, same day dosing is as effective as split dosing.

  1. Bust the most common colonoscopy myths, one by one

If a patient seems reluctant, strike up a conversation to determine if they have any misconceptions about colonoscopy. Simply discussing the pros and cons of the procedure, or helping them determine if their insurance provides coverage, can help dispel some of these myths and improve willingness to undergo the procedure.

Myth 1: The procedure is uncomfortable

Many patients do not realize that they will be asleep during the procedure.

Myth 2: Colonoscopy requires several days off from work

Most patients can get by with two days off from work, or even 1.5 days in some cases, with the last half of one day for the prep and the first half of the next day for the procedure. The anesthesia can cause drowsiness, so most patients do prefer to take the entire second day off.

Myth 3: Insurance does not cover colonoscopy

Most insurance companies cover the cost. Referring patients to your business office for guidance can set a patient’s mind at ease.

Myth 4: There is a high risk of complications for colonoscopy

While all invasive procedures present risks, the estimated risk of perforation is about 1 in 1000 colonoscopies (0.14 percent), while the risk for colorectal cancer is about 1 in 23 for men (4.3 percent) and 1 in 25 for women (4.0 percent).

  1. Participate in Colon Cancer Awareness Month

Colon Cancer Awareness Month, or National Colorectal Cancer Awareness Month, is a great time to improve the perception of colonoscopy. The Colorectal Cancer Alliance offers a number of ways to bring awareness to this important test through “Get Checked” Screening Pledge, “Dress in Blue Day,” and opportunities to volunteer. The Colorectal Cancer Alliance is even glad to send you 100 free colorectal cancer awareness brochures to give to your patients.

Perhaps the most important step in improving the perception of colonoscopy is to open a dialog with your patients. While you may never change how some patients view colonoscopy, you may be able to sway the opinions of others. It is always important to try, considering the consequences of catching colorectal cancer too late.


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