The effect of primary care physician counseling on participation rate and use of sedation in colonoscopy-based colorectal cancer screening program – a randomized controlled study

Abstract

Objectives. Physician recommendation is a strong predictor of colorectal cancer (CRC) screening adherence, but there are no sufficient data specific to primary colonoscopy screening programs. The primary objective was to compare the effect of primary care physician's (PCP) counseling with information leaflet about CRC screening on participation rate in opportunistic primary colonoscopy screening program. Secondary objective was to determine the impact of this counseling on a decision to choose unsedated colonoscopy. Material and methods. Six hundred consecutive subjects 50–65 years of age visiting PCP group practice for routine medical consultation were randomly assigned in a 1:1 ratio either to discuss CRC screening with PCP or to receive an information leaflet on CRC screening only. The outcome measures were the participation rate and the proportion of unsedated colonoscopies assessed on subjects' self-reports collected six months after the intervention. Multivariate logistic regression model with backward selection was used to investigate the association between independent covariates and binary endpoints. Results. Participation rate was 47.0% (141 subjects) in the counseling group and 13.7% (41 patients) in the information leaflet group. The rates of unsedated colonoscopies were 77.0% and 39.0%, respectively. In a multivariate analyses, PCP's counseling was associated with higher participation in CRC screening (adjusted odds ratio [OR] 5.33, 95% confidence intervals [95% CI] 3.55–8.00) and higher rate of unsedated colonoscopies (OR 7.75, 95% CI 2.94–20.45). Conclusion. In opportunistic primary colonoscopy screening, PCP's counseling significantly increases participation rate and decreases demand for sedation compared to recruitment with information materials only. NCT01688817.

Key Words::

• colonoscopy
• colorectal neoplasms
• conscious sedation
• early detection of cancer
• patient participation
• patient selection
• physicians
• primary care

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. Funding: Medical Centre for Postgraduate Education grant number 501-2-3-02-33/09 and Polish Foundation of Gastroenterology.

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