Inpatient Intervention as a Screening Instrument for Colorectal Cancer: Phase I

Abstract

Purpose: Colorectal cancer screening decreases colorectal cancer incidence and mortality. Despite public education regarding its benefit, screening colonoscopy is underutilized. Studies reviewing outpatient models of interventions have not increased colon cancer screening awareness or screening colonoscopy rates. However, it has been noted that interventions during hospital admissions have demonstrated improvements in rates of immunization for influenza and pneumococcal disease. Our goal is to demonstrate that intervention at the time of hospitalization will both raise awareness regarding colorectal cancer screening and result in increased screening rates. Methods: Our study is divided into two phases. Phase I uses a 10 item multiple choice questionnaire given to patients admitted to the Hospitalist service of our tertiary care medical center who were identified as meeting accepted criteria for outpatient screening colonoscopy (per currently accepted colorectal cancer screening guidelines) and without any acute medical issues warranting an inpatient colonoscopy. The questions asked in Phase I pertain to the attitudes and opinions of the patients regarding screening colonoscopy and whether they would be willing to undergo screening for colorectal cancer. A colonoscopy information pamphlet was provided to the patients at the time of the questionnaire. Questions regarding screening colonoscopy were answered by the health care professional administering the questionnaire. Phase II, currently in progress, involves contacting these patients 6 months after their hospitalization to ascertain if they have undergone colorectal cancer screening. Results: 30 patients (14 male) completed the Phase I questionnaire. The mean age was 60.6 with a median of 59. 63% were Caucasian, 23% African-American, and 14% Hispanic, Asian, and other. 87% of the patients were aware that colonoscopy for colorectal cancer screening was recommended but had not yet pursued screening. Fear of the procedure was cited by 27% of the patients. 14% reported fear of health care providers and tests in general. 28% reported fear of subsequent procedures following colonoscopy. 24% reported knowing someone who had a bad experience with colonoscopy. 34% felt that the bowel preparation was too difficult. After the questionnaire and information handout were reviewed, and all questions were answered, 90% of the interviewees reported willingness to undergo outpatient screening colonoscopy within the next 6 months. Conclusion: Inpatient intervention appears to raise awareness of colonoscopy for colorectal cancer screening, with 90% of patients reporting willingness to undergo outpatient colonoscopy.