what is a pre colonoscopy visit to a doctor

• Journal List
• Br J Cancer
• v.107(seven); 2012 Sep 25
• PMC3461154

Br J Cancer. 2012 Sep 25; 107(7): 1051–1058.

Contiguous vs telephone pre-colonoscopy consultation in colorectal cancer screening; a randomised trial

E M Stoop,^{1, 6, *} T R de Wijkerslooth,^{ii, six} P M Bossuyt,³ J Stoker,⁴ P Fockens,² E J Kuipers,^{1, 5} E Dekker,² and M E van Leerdam¹

E G Stoop

¹Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, 's-Gravendijkwal 230, 3015 CE Rotterdam, The netherlands

T R de Wijkerslooth

²Department of Gastroenterology and Hepatology, Academic Medical Eye, Meibergdreef 9, 1105 AZ Amsterdam, Kingdom of the netherlands

P M Bossuyt

³Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The netherlands

J Stoker

^fourSection of Radiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The netherlands

P Fockens

²Section of Gastroenterology and Hepatology, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, Kingdom of the netherlands

East J Kuipers

¹Department of Gastroenterology and Hepatology, Erasmus Academy Medical Centre, 's-Gravendijkwal 230, 3015 CE Rotterdam, The netherlands

^vDepartment of Internal Medicine, Erasmus University Medical Centre, 'southward-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands

East Dekker

²Department of Gastroenterology and Hepatology, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

Grand E van Leerdam

¹Department of Gastroenterology and Hepatology, Erasmus Academy Medical Centre, 'south-Gravendijkwal 230, 3015 CE Rotterdam, Kingdom of the netherlands

Received 2012 Apr three; Revised 2012 Jul 9; Accepted 2012 Jul thirteen.

Abstruse

Groundwork:

A pre-colonoscopy consultation in colorectal cancer (CRC) screening is necessary to assess a screenee's general health status and to explain benefits and risks of screening. The first option allows for personal attending, whereas a telephone consultation does non crave travelling. We hypothesised that a phone consultation would lead to higher response and participation in CRC screening compared with a contiguous consultation.

Methods:

A total of 6600 persons (50–75 years) were 1 : 1 randomised for primary colonoscopy screening with a pre-colonoscopy consultation either face-to-face or by telephone. In both arms, nosotros counted the number of invitees who attended a pre-colonoscopy consultation (response) and the number of those who subsequently attended colonoscopy (participation), relative to the number invited for screening. A questionnaire regarding satisfaction with the consultation and expected burden of the colonoscopy (scored on five-point rating scales) was sent to invitees. Besides, a questionnaire to assess the perceived burden of colonoscopy was sent to participants, fourteen days afterward the procedure.

Results:

In all, 3302 invitees were allocated to the phone group and 3298 to the contiguous grouping, of which 794 (24%) attended a telephone consultation and 822 (25%) a face-to-face consultation (P=0.41). Later, 674 (xx%) participants in the phone group and 752 (23%) in the face-to-face grouping attended colonoscopy (P=0.018). Invitees and responders in the telephone grouping expected the bowel preparation to be more painful than those in the contiguous group while perceived brunt scores for the full screening procedure were comparable. More than subjects in the face-to-face grouping than in the phone grouping were satisfied by the consultation in general: (99.eight% vs 98.five%, P=0.014).

Decision:

Using a telephone rather than a face-to-face consultation in a population-based CRC colonoscopy screening programme leads to similar response rates simply significantly lower colonoscopy participation.

Keywords: colonoscopy/*methods, colorectal neoplasms*, humans, interviews every bit topic/methods, mass screening/methods, prevention and command

Screening programs for colorectal cancer (CRC) are existence implemented in almost Western countries. In 2009, 19 out of 27 European countries had established or were preparing a population-based or opportunistic CRC screening programme (Zavoral et al, 2009). Although screening for CRC is gaining acceptance throughout the world, a consensus on the preferred strategy is still lacking. Colonoscopy is a colorectal examination with a high accurateness to find colorectal neoplasia and i of the recommended screening strategies by the Usa Taskforce (Levin et al, 2008). Colonoscopy is, however, a burdensome procedure that requires consummate colon lavage. For a primary screening test, it has a relatively high complication rate of 0.1–0.three% (Nelson et al, 2002; Panteris et al, 2009). When colonoscopy is used as a primary screening method, the risks and benefits of screening therefore have to be explained to participants before screening to enable informed determination making. Too, information on a person's medical history and medication utilize should be obtained to anticipate on possible risks during colonoscopy. On i hand screenees need to be fairly informed on the risks and benefits of the procedure, and on the other hand the endoscopist and screening organisation crave adequate information on the health condition of the individual screenee and the need for any specific precautions. Both aims can exist achieved in a pre-colonoscopy consultation.

Nigh hospitals in the netherlands invite patients at the outpatient clinic prior to colonoscopy. Although this is working well in daily clinical practice, it may overload the outpatient clinic when used in screening.

An alternative for a face up-to-face consultation could be a telephone consultation. Travelling to and from the hospital with absence from home or work would no longer be necessary, which could facilitate participation. On the other paw, bowel preparation may exist less well explained during phone conversations, which would pb to lower quality exams. Telephone conversations may provide less room for boosted questions, leading to lower satisfaction levels and inferior participation rates. Furthermore, participants' expected burden of the colonoscopy might be influenced by the type of assessment.

The master aim of this randomised trial was to compare the response rate and participation rate with pre-colonoscopy assessment by telephone to that of a face-to-face consultation at the outpatient clinic. Secondary outcomes were participants' satisfaction, expected and perceived burden and quality of bowel preparation. Our a priori hypothesis was that more invitees would have a pre-colonoscopy cess in the telephone group than in the face up-to-face grouping, considering these invitees could stay at home or at piece of work during the consultation. We expected that a higher response charge per unit in the phone grouping would atomic number 82 to a college colonoscopy participation rate, because these invitees would take to come to the infirmary only once. We also expected participants in the face-to-face grouping to exist more satisfied with the consultation and that the quality of bowel preparation would exist college in this group. We anticipated no departure betwixt both groups regarding expected burden and perceived burden of the colonoscopy.

Materials and methods

Randomisation and invitation

A grouping of 6600 persons aged 50–75 years of the general Dutch population in the regions Amsterdam and Rotterdam was randomly allocated, prior to invitation, to either a face up-to-face pre-colonoscopy consultation (due north=3298) or a telephone consultation (n=3302) (Figure ane). Individuals were identified using the electronic databases of the regional municipal administration registration. Randomisation was performed per household. The randomisation was performed past TENALEA, using ALEA Randomisation software (version 2.2) (Netherlands Cancer Constitute, Amsterdam, Holland), based on a minimisation algorithm taking into account age (fifty–55, 55–60, 60–65, 65–70 and 70–75), gender and socio-economic status (very low, low, average, high and very high). At the time of the trial, the Netherlands did non have a CRC screening programme.

Study menstruation: response, participation and questionnaire completion. *Only a subsequent subset of 5924 invitees received the baseline questionnaire. The participants who belonged to this subset received the PBQ. The proportions of completed EBQ, SQ or PBQ are relative to this subset. **Not-participant who attended the consultation. ***Subjects with CRC-related symptoms. Abbreviations: EBQ=expected burden questionnaire; GP=general practitioner; PBQ=perceived burden questionnaire; SQ=satisfaction questionnaire.

All individuals were invited between June 2009 and July 2010 by the Regional Comprehensive Centres in Amsterdam and Rotterdam. They received a pre-announcement, followed by an invitation and an information leaflet, containing information on CRC in general, the advantages and disadvantages of screening, possible risks and follow-up in instance of a positive examination event. If invitees failed to respond, they were sent a reminder letter of the alphabet 4 weeks later for the aforementioned cess blazon as in the showtime invitation (de Wijkerslooth et al, 2010). The overall design of the COCOS (COlonoscopy or COlonography for Screening) trial has been described in detail previously (de Wijkerslooth et al, 2010). The chief outcomes of the COCOS trial (participation rate and diagnostic yield) were published recently (Stoop et al, 2012). Ethical approving was obtained from the Dutch Health Council (2009/03WBO, The Hague, Holland). The trial was included in the Dutch trial register prior to its initiation: NTR1829 (www.trialregister.nl).

Pre-colonoscopy assessment

At 2 bookish centres in holland, face up-to-confront and telephone pre-colonoscopy consultations were performed by clinical research staff. A formalized consultation was performed with standardized questions (Table 1) using a shared database in both hospitals. For both consultation types, 30 min were scheduled. During the consultation, possible screening exclusion criteria were discussed. Persons were excluded when they had had a full colonic exam (colonoscopy, double dissimilarity barium enema or CT colonography) in the previous v years or when they were in a surveillance programme because of a personal history of CRC, colonic adenomas or inflammatory bowel illness. Persons with an cease-stage disease and a life expectancy <5 years were also excluded.

Table ane

Standardised questions asked during pre-colonoscopy consultation

Standardised questions asked in both academic centres

Have you noticed rectal blood loss or changed bowel habits during the last 3 months?

Are you lot suffering from whatsoever chronic diseases, such equally diabetes or asthma?

Are you lot suffering from any current diseases and if so, is specialized treatment necessary?

Have you ever been severely ill or admitted to the hospital? Have yous ever had surgery?

Are you suffering from whatsoever chest pain, orthopnea, angina or do tolerance?

Are y'all taking medication and what are the corresponding dosages?

How alpine are you and what is your weight? What is your nationality?

Do you utilise tobacco, booze or drugs? And if so, how many times a day?

Do yous take outset-degree relatives who have/had been diagnosed with CRC? Practise y'all accept first-degree relatives with hereditary diseases, such as FAP or Lynch syndrome?

If additional information was needed on possible exclusion criteria or contraindications for the screening procedure, the general practitioner or medical specialist was contacted for further information. In the telephone group, respondents were invited at the outpatient dispensary if the research staff felt that the phone consultation had been inadequate.

During the second function of the consultation, information was given regarding the colonoscopy itself. Duration, discomfort and possible complications, such as haemorrhage or perforation (0.1–0.iii%), were discussed. The inquiry staff explained about the possibility of using conscious sedation (midazolam) and/or analgesics (fentanyl) during the procedure.

Invitees received detailed information about the bowel preparation during the consultation. In improver, they were handed bowel preparation materials. In the telephone group, this was distributed past postal service. At the stop of the consultation, information was given on how test results would be reported and corresponding follow-up measures. Informed consent was discussed during the assessment and, later, an informed consent form was sent by postal mail to potential participants together with an data leaflet for reference. Participants were asked to return the informed consent class by mail earlier the scheduled colonoscopy.

At the terminate of the consultation, an appointment was made for the actual colonoscopy. All individuals who agreed to participate were sent a confirmation of the appointment for colonoscopy.

Baseline questionnaire

The beginning 5924 invitees received a validated baseline questionnaire by postal mail. Respondents to the kickoff screening invitation received the questionnaire afterward the prior consultation, within 4 weeks before the scheduled colonoscopy. Invitees who had non responded to the initial invitation received the same baseline questionnaire four weeks later the initial invitation, together with the reminder. All individuals were asked to complete the questionnaire and to render it by mail in a pre-paid envelope.

The baseline questionnaire comprised items regarding satisfaction with the prior consultation (SQ) and expected burden (EBQ) of the colonoscopy (Table two). Items on satisfaction were based on a previously validated questionnaire on satisfaction in eight university hospitals in The Netherlands (Prismant: Trends in tevredenheid, 2008). Satisfaction was scored on a four-signal scale ranging from very satisfied to very unsatisfied. Expected burden was itemised into expected embarrassment, pain and burden of the bowel preparation and the colonoscopy itself and was previously validated (van Gelder et al, 2004; Denters et al, 2009; Hol et al, 2010). The EBQ burden items such equally embarrassment, hurting and brunt during the process were scored on v-bespeak rating scales labelled equally non embarrassing, painful or crushing, to extremely embarrassing, painful or crushing (1=not at all; ii=slightly; three= somewhat; 4=rather; and v=extremely). The questionnaire as well collected information on background characteristics, such every bit educational and income levels. Completed baseline questionnaires were scanned and responses were automatically transferred to a database.

Table two

Questions asked in baseline questionnaire regarding satisfaction and expected burden

Satisfaction regarding the consultation

How satisfied are you lot with the personal attention?

How satisfied are you with the opportunity to inquire questions?

How satisfied are you with the clarity of the information given during the assessment?

How satisfied are you with the assessment in general?

Expected burden of colonoscopy screening

How embarrassing do you expect the bowel training to exist?

How painful do y'all expect the bowel training to exist?

How burdensome do you lot expect the bowel training to exist?

How embarrassing do you expect the colonoscopy to exist?

How painful do yous expect the colonoscopy to be?

How burdensome do you expect the colonoscopy to be?

Perceived burden questionnaire (PBQ)

A PBQ was sent to screening participants, 2 weeks subsequently the colonoscopy (Effigy 1). Participants received this questionnaire together with their concluding test results. Participants were asked to fill in the PBQ questionnaire directly afterwards receiving it and to return by mail in a pre-paid envelope. If participants did not respond, they were not reminded. This questionnaire had too been previously validated (van Gelder et al, 2004; Deutekom et al, 2006; Denters et al, 2009; Hol et al, 2010). It comprised colonoscopy-related items besides as items on the full procedure (including bowel preparation, colonoscopy itself, post-procedure follow-upward and waiting for the test results). The perceived burden questions are listed in Table 3. All burden items were scored on a 5-indicate rating scale ranging from not embarrassing, painful or crushing to extremely embarrassing, painful or burdensome (1=not at all; 2=slightly; three= somewhat; four=rather; and five=extremely). Participants were likewise asked well-nigh their willingness to participate in a time to come screening round (one=admittedly not; 2=probably not; 3=probably; and 4=certainly). Completed PBQs questionnaires were scanned and responses were automatically transferred to a database.

Table 3

Questions asked in perceived brunt questionnaire

Bowel training

How embarrassing did you find the bowel preparation?

How painful did y'all notice the bowel preparation?

How burdensome did you notice the bowel preparation?

Insertion of the colonoscope

How embarrassing did y'all find insertion of the colonoscope?

How painful did you discover insertion of the colonoscope?

How crushing did you detect insertion of the colonoscope?

The rest of the examination

How embarrassing did you find the remainder of the colonoscopy?

How painful did you find the rest of the colonoscopy?

How burdensome did you detect the remainder of the colonoscopy?

Waiting for the exam results

How burdensome did you notice waiting for the test results?

The colonoscopy procedure overall

How embarrassing did you observe the colonoscopy procedure overall?

How painful did you find the colonoscopy procedure overall?

How burdensome did you find the colonoscopy procedure overall?

Participation in a future screening round

Would you participate in a futurity colonoscopy screening circular?

Colonoscopy

All colonoscopies were performed past experienced gastroenterologists (⩾1000 colonoscopies) co-ordinate to the standard quality recommendations of the American Society of Gastrointestinal Endoscopy (Rex et al, 2006). Witting sedation (midazolam) and analgesics (fentanyl) were administered intravenously at the discretion of the participant and the endoscopist. Withdrawal time was at least half-dozen min. For bowel preparation, two l of polyethylene electrolyte glycol solution (Moviprep; Norgine BV, Amsterdam, The Netherlands) together with 2 l transparent fluid and a depression-fibre nutrition for 2 days were used. Bowel grooming was scored using the validated Ottawa bowel training score (Rostom and Jolicoeur, 2004) and classified every bit first-class (0–3), adept (4–6), sufficient (7–10) or inadequate (11–14). In instance of inadequate bowel training, the colonoscopy was interrupted and re-scheduled, unless the participant refused to undergo re-colonoscopy.

Data assay

The analysis was based on the intention-to-screen principle. The primary effect measures were the response charge per unit, defined as the number of invitees attention the pre-colonoscopy consultation relative to the total number of invitees, and the participation rate, defined as the number of invitees who underwent a colonoscopy relative to the total number of invitees. Differences in response and participation rates betwixt groups were evaluated using Chi-square test statistics. Results were not adjusted for clustering, as in most instances at that place were only i or two eligible subjects per household. Items on satisfaction of the consultation and expected and perceived burden of the colonoscopy were expressed as mean scores and compared using Isle of mann–Whitney U-test. Expected burden was compared for all invitees, responders (invitees who attended the consultation) and not-participants (responders who did non attend the colonoscopy). In the analysis of the expected burden and satisfaction scores for responders, questionnaires were excluded if completed before the consultation. All the baseline questionnaires that had not been completed before the colonoscopy were excluded from the assay. Quality of bowel training was expressed as percentages per category and compared using Chi-square statistics. The software programme SPSS for Windows, version 18 (SPSS Inc., Chicago, IL, USA) was used for all of the analyses.

Sample size

We expected an overall participation rate of 25% in colonoscopy screening. We predictable a participation rate of 22.5% in the face-to-confront group vs 27.5% in the telephone consultation grouping. Including 5000 invitees in this trial would result in a power of 98% to reject the null hypothesis of no deviation, using two degrees of freedom Chi-foursquare test with a significance level prepare at 0.05.

Results

Response and participation

Figure 1 summarises the study flow. In the telephone grouping, 794 of the 3302 invitees (24%) attended the pre-colonoscopy consultation vs 822 of the 3298 invitees (25%) in the face-to-confront group. This difference in response rate was not significant (P=0.41). (Effigy 1) One responder in the phone group was invited at the outpatient clinic considering of severe comorbidity and was later excluded from colonoscopy.

In total, 18 participants in the telephone group and 14 in the face-to-face group were excluded after the pre-colonoscopy assessment because they met one or more exclusion criteria. After the pre-colonoscopy consultation, 102 responders in the telephone grouping and 65 in the face-to-face group decided non to undergo a colonoscopy. The participation rate was significantly lower in the phone group: 674 invitees (20%) had a screening colonoscopy later the phone consultation vs 752 (23%) in the confront-to-face group (P=0.018). Demographic characteristics of responders and participants are listed in Table 4.

Table iv

Demographic characteristics of responders and participants

	Pre-colonoscopy assessment (responders)		Colonoscopy (participants)
Assessment blazon	Face-to-confront	Telephone	Face-to-face	Telephone
Invitees (n)	3298	3302	3298	3302
Responders (northward, %)	822 (25%)	794 (24%)	—	—
Participants (n, %)	—	—	752 (23%)	674 (xx%)
Mean age (twelvemonth, s.d.)	61 (half-dozen.ane)	threescore (6.3)	61 (half dozen.ane)	60 (6.2)
Male (n, %)	419 (51%)	410 (52%)	387 (51%)	339 (fifty%)
SESa (mean, due south.d.)	3.2 (1.4)	3.2 (1.4)	3.2 (1.four)	3.2 (1.4)

Baseline questionnaire

Expected burden among all invitees

We had to exclude 27 questionnaires that were returned subsequently the colonoscopy. Questions on expected burden were completed by 1083 of 2958 individuals (37%) invited for a face-to-face consultation and by 1001 of 2966 individuals (34%) invited for a telephone consultation.

Effigy two summarises the expected burden scores of all invitees. Reluctance to undergo screening was comparable in both groups. The expected embarrassment and burden of the bowel preparation was scored comparable in both groups. A larger proportion of invitees allocated to the telephone consultation expected the bowel grooming to exist somewhat painful: 26% vs 22%, with an overall hateful score of 2.4 vs 2.3 (P=0.03). Hateful scores for expected embarrassment, hurting and burden of the colonoscopy itself were not statistically unlike betwixt the two groups.

Reluctance to undergo colonoscopy and expected embarrasement, pain and burden of bowel prep and colonoscopy. On tiptop of the bars, hateful score, s.d. (between parantheses), difference in mean scores and pooled south.d. (pSD) are displayed. Expected pain of the bowel preparation differed significantly between the groups (P=0.03), all other items were not statistically unlike.

Expected burden amidst responders (invitees who attended the consultation)

Items on expected burden were completed by 578 of the 736 responders (79%) who attended a face-to-face consultation and by 524 of the 701 responders (75%) with a telephone consultation. Mean expected embarrassment and burden scores of the bowel preparation were like for the ii groups; the expected pain of the bowel preparation was rated college in the phone group: 20% in the telephone group expected information technology to exist rather painful vs 16% in the face-to-face group; overall mean scores were ii.one vs ii.0 (P=0.03). Expected embarrassment, pain and burden of the colonoscopy itself were similar for both groups.

Expected burden in non-participants who did attend the consultation

In the telephone group, 33 of the 102 not-participants (32%) completed the questions on expected burden vs 24 of the 56 (43%) in the face-to-face up group. Scores on expected embarrassment, hurting and brunt of the bowel preparation and the colonoscopy itself did not significantly differ betwixt the groups.

Satisfaction amidst responders

A total of 585 of the 736 responders (79%) in the face-to-face group completed the items on satisfaction afterwards the consultation, vs 472 of the 701 responders (67%) in the telephone group. Tabular array v summarises the level of satisfaction during the consultation for both groups.

Tabular array 5

Level of satisfaction

Satisfaction	Face-to-face due north =585	Telephone n =472	P -value
The assessment in general	1.lx (s.d. 0.49)	1.69 (s.d. 0.fifty)	0.004
Possibility to ask questions	1.61 (south.d. 0.49)	1.70 (s.d. 0.49)	0.002
Personal attention	1.threescore (due south.d. 0.49)	ane.72 (s.d. 0.48)	<0.001
Clarity of information	ane.64 (s.d. 0.49)	one.75 (due south.d. 0.48)	<0.001

Nigh all responders in the face-to-face group and in the phone group indicated to be (very) satisfied with the cess in general (99.viii% vs 98.5%, P=0.014). Responders reported to exist (very) satisfied with the personal attending from the research staff: 98.ix% in the phone group vs 100% in the face-to-face group (P=0.011). The clarity of the information given during the assessment was scored every bit (very) satisfying by 98.v% in the telephone grouping vs 99.5% in the face-to-face grouping (P=0.x). All responders (100%) in the face-to-face group expressed beingness satisfied with the possibility to ask questions vs 99.i% in the telephone group (P=0.023).

Bowel grooming

Iv colonoscopies in the telephone group and three in the face-to-face grouping had to exist re-scheduled because of an inadequate bowel preparation. Mean Ottawa scores for the quality of the bowel preparation in participants were similar: v.vii in the telephone grouping vs v.six in the face-to-face group (P=0.54) (Table 6).

Table half-dozen

Quality of bowel preparation

Satisfaction	Face-to-face due north =752	Telephone north =674	P -value
Fantabulous (0–iii)a	225 (xxx%)	203 (thirty%)	0.92
Skillful (4–half dozen)a	327 (43%)	283 (42%)	0.58
Sufficient (vii–x)a	135 (xviii%)	118 (18%)	0.84
Inadequate (11–14)a	57 (8%)	62 (ix%)	0.27
Missing	viii (1%)	8 (1%)	0.83

The perceived burden

In the telephone group, 574 (85%) colonoscopies were performed under conscious sedation in combination with analgesics compared with 647 (86%) colonoscopies in the face-to-face group. (P=0.40). The PBQ was completed by 477 of 674 (71%) participants with a telephone consultation and 529 of 752 (70%) participants with a face-to-face consultation. Scores on perceived embarrassment, pain and burden of the full screening procedure were similar in both groups (Effigy three). In participants, 95.5% in the telephone group and 96.ii% in the contiguous group would (probably) participate in a future screening round (P=0.58).

Perceived embarrasement, pain and brunt of the unabridged screening procedure (including bowel preparation colonoscopy itself, waiting for the test results, and abdominal complaints). On acme of the bars, mean score, southward.d. (betwixt parantheses), deviation in mean scores and pSD are displayed. None of the items were statistically different betwixt the groups: pain (P=0.06), embarrassement (P=0.96) and brunt (P=0.75).

Discussion

Nosotros compared pre-colonoscopy consultation by phone with face-to-face cess in a population-based CRC screening programme in average-risk subjects. The response rate was similar for phone and contiguous assessments, with about 25% of the invitees having the assessment. Colonoscopy participation on the other hand was significantly college amongst individuals in the face-to-face group. Satisfaction was marginally, but significantly, lower and expected burden scores higher later phone assessment.

Our report has several strengths. All invitees in this randomised controlled trial were screening naive subjects and were randomly selected prior to the invitation to i of the ii consultation types. Invitees received an invitation for only one of the 2 consultation types in combination with an identically designed detailed information leaflet. In this way, information supply and determination making was kept as unproblematic and clear as possible. Information provided during the consultation was kept similar; a standardised questionnaire was used to keep the ii cess types comparable. In each centre, the aforementioned inquiry staff performed both types of assessments, minimising bias in the comparison. Nevertheless, differences may have occurred in the data exchanged with invitees. At the outpatient clinic, information supply can be simplified and made clearer using visual aids, for case.

In our report, 20% of the invitees in the phone group participated in screening and 23% in the contiguous grouping. This compares well with the attendance rates in other colonoscopy screening programs. The participation charge per unit in colonoscopy population screening in Commonwealth of australia was 16% (Scott et al, 2004). Two Italian randomized controlled trials, in which invitees were selected past full general practitioners, reported chief colonoscopy participation rates of 10 and 27% (Segnan et al, 2007; Lisi et al, 2010). The annual participation rates for the age group 55–69 years in the opportunistic colonoscopy screening programme in Deutschland are 3% for men and 4% for women (Brenner et al, 2009).

To our noesis, just 1 previous, non-randomised study compared a face-to-confront pre-colonoscopy cess with a telephone assessment in CRC screening using gFOBT as the primary screening method (Rodger and Steele, 2008). This retrospective written report, performed in Scotland, compared participation, satisfaction of the participant, and quality of bowel preparation in 316 gFOBT-positive participants in the showtime year of screening (with a contiguous consultation) with 388 gFOBT-positive participants in the 2nd year of screening (with a choice for contiguous or telephone consultation). Overall, colonoscopy attendance was significantly higher in the 2d year: 99% vs 85%. These results are difficult to compare with ours, because of the non-randomized nature of the study and the optional choice for a face-to-face interview in the second twelvemonth. Both in the Scottish study and in our study, quality of bowel preparation did non differ between the 2 groups.

Prior to colonoscopy, authentic information on bowel preparation must be provided to perform a loftier-quality examination. Inadequate bowel preparation can result in missed lesions, cancelled procedures, increased procedural time and a potential increase in complication rates. Adherence to instructions for training can exist achieved by an authentic explanation prior to colonoscopy. Characteristics similar historic period, gender, weight and comorbidity must be obtained before colonoscopy, because these may influence the quality of bowel grooming (Chung et al, 2009). Here besides, in screening participants, nosotros constitute no meaning differences between both groups. This indicates that a telephone interview can be an adequate manner for preparing participants for colonoscopy.

In our study, we establish pregnant differences in satisfaction between groups. It is conceivable that when participants experience satisfied with the personal attention and the opportunity to ask questions, they will be more compliant with screening. Ane may assume that a high level of satisfaction strengthens continuity of the participant–physician relationship (Ware and Hays, 1988; Haddad et al, 2000). Several previous studies have evaluated satisfaction regarding the colonoscopy (Lin et al, 2007; Chartier et al, 2009; Ko et al, 2009). In concordance with our results, usually very high satisfaction rates are institute (Rosenthal and Shannon, 1997).

Expected burden may as well influence participation in CRC screening. If invitees wait the colonoscopy to exist highly burdensome, they can determine, before or afterwards the pre-colonoscopy assessment, not to undergo colonoscopy (Multicentre Australian Colorectal-neoplasia Screening (MACS) Group, 2006; Ko et al, 2009). Expected brunt can be influenced by the way the data is provided during the pre-colonoscopy assessment. In our study, significantly more invitees and responders in the telephone group expected the bowel grooming to be painful than in the confront-to-face group. Non only expected burden but likewise perceived burden of colonoscopy influences the participation rate in hereafter screening rounds. In our study, perceived brunt was comparable betwixt both groups, also as the willingness to participate in a time to come screening circular (96%). This suggests that the fashion of pre-colonoscopy cess does not affect the experience of bodily screening participants.

Actual differences in satisfaction and expected burden scores between both groups were small, which makes the clinical relevance arguable. In a review published in 2003, the minimally important divergence for health-related quality of life instruments was computed. In this review, the authors concluded that, to indicate clinical relevance, a divergence of at least half a s.d. is needed (Norman et al, 2003). However, CRC screening by definition has to deal with large populations, and the impact of screening fully relies on consistent participation during repeated screening rounds. Equally such, minor differences go relevant.

It is possible that other factors, besides expected brunt and satisfaction with the assessment, caused invitees in the telephone grouping to refrain more than often from actual participation. Unfortunately, a considerable proportion of responders who did not attend colonoscopy failed to written report the reason for not participating. Maybe the way in which the contact is initiated affects the developing physician–patient relationship. Nosotros know from other studies that this relationship can exist influenced by the fashion participants are approached (Ha and Longnecker, 2010; Moretti et al, 2012). Non-verbal communication between a md and a patient affects patient'due south satisfaction. Behaviour such as sitting close to the patient and leaning forrad have been associated with higher patient satisfaction (Roter et al, 2006; Pawlikowska et al, 2012). A Dutch study reported on finish points in medical advice to improve physician–patient advice (de Haes and Bensing, 2009). The authors suggested that ane of the ways to check if a expert medico–patient relationship is being established is to have eye contact with the patient, something which is evidently non possible during a telephone chat. Having middle contact also enables the dr. to check whether information given during the assessment is understood.

Although, response rates in both groups were similar, the telephone group had a higher post-consultation drop-out charge per unit, or in other words a lower post-consultation uptake of colonoscopy, which is of key importance for the bear upon of CRC screening. The uptake rate of colonoscopy using a phone consultation needs to be improved. Therefore, farther research should focus on how to enhance colonoscopy participation charge per unit later a telephone consultation. Perchance an interactive conversation using a computer or information nigh the screening colonoscopy on video might increase commitment. Besides, information supply could be done using internet or email.

There may be alternatives to the contiguous assessment as done in this written report to evaluate and inform potential screening participants. One instance is the additional utilize of a pre-cess questionnaire. Future research should investigate the prophylactic and preference of additional measures for improving pre-colonoscopy assessment in colonoscopy screening.

In summary, we found that a similar number of invitees responded to an invitation for a telephone consultation and to an invitation for a face-face up consultation in a population-based CRC screening programme using colonoscopy equally the primary screening method. The number of invitees who decided not to participate was significantly higher subsequently the telephone assessment, whereas satisfaction was lower and expected brunt higher. We therefore practise not recommend switching to telephone consultation in chief colonoscopy screening programmes for CRC.

Acknowledgments

This work was funded by the Netherlands System for Wellness Enquiry and Development of the Dutch Ministry of Wellness (ZonMW 120720012 and 121010005) and by the Centre for Translational Molecular Medicine (CTMM DeCoDe-project). None of the organisations had admission to the data.

Author contributions

ES and TW contributed equally in writing the article. ED and JS obtained funding. ED, JS, EK and MvL carried out study supervision. All the authors provided: study concept and design; conquering of data; analysis/estimation of information; drafting of the manuscript; disquisitional revision of the manuscript for important intellectual content; and concluding approving of the version to be published.

This work is published under the standard license to publish agreement. Subsequently 12 months the work volition become freely available and the license terms will switch to a Creative Eatables Attribution-NonCommercial-Share Akin 3.0 Unported License.

The authors declare no conflict of interest.

09/10/2012

This paper has been modified since advance online publication, an acknowledgement has been added

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3461154/#:~:text=A%20pre%2Dcolonoscopy%20consultation%20in,consultation%20does%20not%20require%20travelling.

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