How Accurately Do Patients Report Their Colonoscopy Results?

Abstract

Background: Current colorectal cancer screening guidelines recommend that young (age <60) adenoma patients (and their first degree relatives) be treated as having an increased risk of colorectal cancer, and undergo colon surveillance more frequently than the general population. However, for such guidelines to be realized, patients themselves need to be accurately informed of their adenoma diagnosis. We conducted a pilot study to determine how accurately colonoscopy patients can report their results. Methods: Patients at a single institution aged 50-60 who underwent a colonoscopy in the previous year were mailed a survey and consent form to allow review of their medical records. Patients were asked whether they were told that they had a polyp, and if so, which terms were used to describe the polyp (options were adenoma, hyperplastic, benign, precancerous, and other). Two coders independently reviewed the colonoscopy and pathology reports to determine “true” polyp status. Results: Of 200 mailed surveys, 5 were returned as “wrong address”, 1 participant indicated that they were never colonoscoped, and 1 was intellectually impaired, leaving 193 eligible participants of whom 53 (27%) returned completed surveys. Medical records were reviewed for 46 patients. Of the 31 patients who did not self-report a polyp, 29 (93.5%) were verified with medical records as clear. Of the 15 who did self-report a polyp, 9 (60%) were verified (6 adenomas and 3 hyperplastic polyps). All of the patients incorrectly reporting a polyp had a biopsy taken during their procedure that was pathologically defined as “benign colonic mucosa”. Overall, 71% of patients reporting accurate results were given their results by the endoscopist vs. 38% of those incorrectly reporting their results (Chi sq. = 8.9; p = 0.031). Patient gender, education, and family history of colorectal cancer were not associated with accuracy of reporting. Conclusions: Patients aged <60 undergoing colonoscopy can accurately report the absence of a polyp, but only 60% accurately report the presence of a polyp. This appears to be due entirely to patients who undergo a biopsy that proves to be normal mucosa upon pathology review. These individuals who mistakenly report that they have a polyp were more likely to have been given their colonoscopy results by someone other than the endoscopist. We conclude that it may be particularly important to ensure that patients with negative biopsy results are provided with timely follow-up results so that they do not perpetuate an inaccurate polyp history, and by extension, an inaccurate personal and familial risk of colorectal cancer.