Lack of Reliability of Self Reports of Patients With Advanced Colon Polyps

Abstract

Introduction: Current guidelines concerning screening for colorectal cancer recommend that the clinician collect self reports of personal and family history in first degree relatives of colorectal polyps, advanced colorectal polyps, and cancer. This clinical strategy is based on the assumptions that patients are knowledgeable about their own polyp history and have communicated and received such information with and from their first degree relatives. The availability of reliable data on patients from 56 endoscopists from four counties in southeast Florida over a 3 year period with biopsy proven advanced colorectal polyp histology (tubulovillous adenoma, villous adenoma) afforded a unique opportunity to explore these assumptions. Methods: Written informed consent was obtained and brief telephone interviews were conducted by trained interviewers for a case series of 84 patients. The questions included knowledge of their own polyp history as well as whether such information was communicated to first degree relatives. Results: Among the 84 wtih biopsy proven advanced colorectal polyp histology, 10 patients (11.9%) were unaware that any polyp had been removed (figure 1). In addition, 46 (54.8%) did not inform their first degree relatives (figure 2). Conclusion: Busy clinicians are faced with the challenging task of obtaining accurate data regarding personal and family history to decide the most appropriate screening strategies for colorectal cancer for each of their patients. In this case series, there is a lack of reliability of self reports by patients with advanced colon polyps. Specifically 11.9% were unaware that any polyp had been removed and 54.8% did not inform their first degree relatives. These data pose an important challenge to clinicians to obtain data more reliable than self reports regarding the personal history of having a polyp as well as the communication of this to first degree relatives. Such reliable data are necessary to improve awareness and optimize screening. Improved automation such as forwarding pathology directly to patients and computer generated reminders encouraging communication with family members at time of diagnosis and in subsequent follow up intervals are possible options that busy clinicians may wish to explore. The availability of reliable data will allow the most rational decision making by the clinician for his or her individual patient as well as policy decisions for the health of the general public.265_A Figure 1. Patient Awareness of Personal Polyp History265_B Figure 2. Patient Communication to First Degree Family Members