Patient preferences regarding colonoscopic lavage preparations

Patient preferences regarding colonoscopic lavage preparations

AJG – September, Suppl., 2002 Purpose: Several studies from major medical centers have reported that upto 90% of patients undergoing endoscopy are wi...

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AJG – September, Suppl., 2002

Purpose: Several studies from major medical centers have reported that upto 90% of patients undergoing endoscopy are willing to undergo such procedures without sedation. According to our experience, these numbers are irrelevant in community setting and most patients actually ask for general anesthesia for endoscopy. We evaluated the willingness of patients in a community to undergo unsedated endoscopy and also assessed any characteristics which may predict such willingness. We also investigated if physicians and GI and non GI nurses would themselves be willing to undergo unsedated endoscopy. Methods: Adult patients who were referred for outpatient colonoscopy and/or EGD were invited to participate in the study. They filled out questionnaires asking for their demographic information and their willingness to undergo endoscopy without sedation. Pre–procedure anxiety level was assessed using Beck Anxiety Inventory. Similar information was obtained from physicians as well as GI and non–GI nursing staff. Results: Total of 295 subjects participated in the study. These included 127 patients, 51 physicians, 61 GI nurses and 56 non GI nursing staff from 6 different hospitals in central Illinois. Only 16.6% of patients and 15% of healthcare professionals were willing to undergo unsedated endoscopy. Physicians were least likely to agree to unsedated endoscopy (2.2%) as compared to patients (16.6%). Overall, there was no significant difference in willingness to forego sedation for EGD vs colonoscopy. Sub– data analysis revealed that 39% of GI nurses agreed to unsedated EGD as opposed to only 19% for colonoscopy. Among non–GI nurses, only 7% agreed to unsedated EGD while none wanted unsedated colonoscopy. Among patients, there was no significant corelation between educational level or anxiety scores and willingness for unsedated endoscopy. Fifteen percent of high school graduates were willing to undergo unsedated endoscopy compared to 18% with college or higher education. Patients with minimal or mild anxiety were just as unlikely to agree to an unsedated endoscopy as the subjects with moderate to severe anxiety (23% vs 19%). Conclusions: Unlike reports from major medical centers, most patients as well as medical professionals in community hospitals are unwilling to undergo unsedated endoscopy.

886 WRITTEN REPORTS IMPROVE PATIENT RECALL OF ENDOSCOPY RESULTS AND RECOMMENDATIONS Jason Poston, Ryan Day and David T. Rubin, M.D.*. Section of Gastroenterology, University of Chicago, Chicago, IL. Purpose: Growing demand for endoscopy associated with colorectal cancer screening has resulted in increased use of open access endoscopy (OAE), in which patients are referred without prior consultation by a gastroenterologist. Previous work has shown that OAE patients are less likely to recall the results or even the type of procedure they have had. We sought to determine whether providing patients with a written copy of their endoscopy report at the conclusion of their procedure enhanced recall of the findings and recommendations. Methods: 80 consecutive outpatients presenting to three endoscopists were randomized to receive the results of their endoscopy via standard verbal report (VR) or by VR followed by receipt of a computer generated endoscopy report (VR⫹WR) from the Olympus ImageManager威 report generator. The endoscopist communicated the VR after a standard post–procedure recovery period, and routinely discussed all findings and recommendations as mentioned in the WR. The endoscopist was blinded as to whether the patient subsequently received the WR. Recall of the endoscopic procedure was assessed using a piloted 11– question survey instrument to be filled– out three days post–procedure. Results were calculated using Fisher exact and Wilcoxon rank–sum tests. Results: 78 of 80 (98%) of patients agreed to participate. 62 (79%) were OAE patients. Of these, response rate was 75% for VR and 73% for VR⫹WR patients. VR⫹WR patients overall had a greater composite score than VR patients (8.8/10 vs. 7.3/10, p⬍0.01). VR⫹WR patients were also significantly more likely to recall the indications for their procedure (100% vs. 85%, p⬍0.05), recommendations for therapy or follow– up (68% vs.



36%, p⬍0.01), whether a biopsy was performed (95% vs. 71%, p⬍0.05), and name of the endoscopist (95% vs.67%, p⬍0.05). When non–OAE patients were included in the analysis, similar statistically significant results were found regarding composite score (p⬍0.01), recommendations (p⬍0.01), and name of the endoscopist (p⬍0.05). Conclusions: A computer– generated endoscopy report significantly improves patient recall of endoscopic procedure information compared to a verbal report alone. Despite this, patients were unable to recall 32% of recommendations. Future work should assess whether patient– directed reports enhance patient satisfaction and follow– up.

887 PATIENT PREFERENCES REGARDING COLONOSCOPIC LAVAGE PREPARATIONS Kirin Kanji, M.D., Sanjay Garuda, M.D. and Michael D. Brown, M.D., FACG*. Section of Digestive Diseases, Rush Presbyterian St. Luke’s Medical Center, Chicago, IL. Purpose: For many patients the most unpleasant part of colonoscopy is the lavage preparation. Over 80% of the preparations for colonoscopy in the U.S. involve the use of a 4L polyethylene glycol (PEG) lavage. Complete consumption of all 4L is achievable by less than 70% of patients and is associated with significant side effects including nausea and dyspepsia. Newer preparations using sodium phosphate (NaP) in liquid or tablet form may be more tolerable and therefore preferred by patients. However, patients are rarely allowed to choose from preparations. We questioned patients on their preferences for preparations after having completed a single screening colonoscopy with either PEG lavage or NaP tablets. Methods: 117 patients undergoing screening colonoscopy for the first time were provided a questionnaire after the procedure describing details of three preparations; PEG lavage, NaP liquid and NaP tablets. 44 patients had received a PEG lavage and 73 had taken a 28 tablet NaP preparation. The patients were asked which preparation they would prefer given similar efficacy during their next colonoscopy. They were also asked if they would prefer to choose their preparation and whether the opportunity to choose a preparation might influence their choice of gastroenterologist. Results: Of the 44 patients who had taken the 4L PEG preparation only 5 (12%) would choose this prep again. 29 (66%) and 10 (22%) would choose NaP tablets and liquid respectively. Of the 73 who had taken NaP tablets, 67 (92%) would take the tablets again whereas 0 (0%) chose the PEG solution. 6 (8%) patients in this group choose the NaP liquid preparation. When patients are given a choice between PEG preparation and NaP tablets, there was a statistically significant difference in favor of the NaP tablets (chi– square ⫽ 81.990, p⬍ 0.0001). Of 113 patients answering the follow up questions, 106 (94%) would prefer to have a choice of preparation and 69 (61%) felt that providing different options for preparations might influence their choice of gastroenterologist. Conclusions: Patients prefer lower volume NaP preparations when allowed to choose a preparation for colonoscopy regardless of their previous preparation. Having a role in this decision is desirable and may influence a patient’s choice of gastroenterologist. 888 IS NORMAL TIBC A GOOD PREDICTOR OF NEGATIVE COLONOSCOPY? Rajeev Jayadevan, M.D., Pallavi Aggarwal, M.D., Edward Norkus, Ph.D., Hilary Hertan, M.D. and Capecomorin Pitchumoni, M.D.*. Gastroenterology, Our Lady of Mercy Medical Center, Bronx, NY. Purpose: To identify predictors of normal colonoscopy in anemic patients who undergo endoscopic investigation. Methods: In an ongoing prospective study of anemia, data on the first 60 consecutive patients were analyzed. Patients had anemia as defined by hemoglobin of ⬍13 g for men and ⬍12 g for women, with at least one of the following parameters: MCV ⬍80 fl, serum iron ⬍ 50 ug/dl, TIBC ⬎250 mg/dl, ferritin ⬍30 ng/ml, absence of overt blood loss or other well