Tu1151 QUALITY OF RECOMMENDATIONS AFTER SURVEILLANCE COLONOSCOPY IN OLDER ADULTS

Abstract

Current guidelines for surveillance colonoscopy in adults age ≥75 recommend that decisions be individualized, which may lead to wide variation in practice patterns. We evaluated the content and clarity of endoscopist-written recommendations after surveillance colonoscopy in older adults. We performed a single center, retrospective, chart review of adults age ≥75 who underwent surveillance colonoscopy. We developed a data collection tool to facilitate data abstraction and minimize inter-observer variability. Kappa scores for recommendation assessments showed substantial agreement. Patient age and gender, endoscopist recommendations for follow-up, and follow-up letters after review of pathology were collected. Recommendations for follow-up were categorized based on content (continue vs. stop surveillance), definitiveness of the recommendation (definitive [e.g., “should,” “recommend”] vs. not definitive [e.g., “could,” “consider”]), and if/what rationale was provided (e.g. “because of your age…”). Differences in recommendations were evaluated using Fisher’s exact test at the 0.05 level of significance. Between 2012-2019, 4453 colonoscopies were performed in adults age ≥75, of which 1324 were for surveillance. We evaluated a subset of these (n=165) using stratified sampling to get a range of patient ages and findings for each endoscopist (n=11). 21.8% of reports contained no recommendation, ranging from 0% to 60.0% by endoscopist. There was a significant difference in the proportion of “stop” versus “continue” recommendation given across all endoscopists (p = 0.001) (Figure 1). There were no discrepancies between colonoscopy reports and post-pathology follow-up letters (Table 1). Among reports that included a recommendation, 69.0% were to continue surveillance, 69.0% were definitive, and 72.1% provided a rationale. There was no significant difference in the definitiveness of the recommendation based on stopping or continuing (p = 0.89). Exams that recommended stopping included a rationale 65.0% of the time, citing: age (57.5%), the current exam being normal (12.5%), overall health (7.5%), and the patient’s history of polyps (7.5%). Exams that recommended continuing included a rationale 76.4% of the time, citing the malignant potential of polyps (34.8%), the patient’s history of polyps (32.6%), and overall health (10.1%). There is considerable variation in the content and clarity of endoscopist recommendations after surveillance colonoscopy in older adults. Over a fifth lacked any recommendation. This study highlights opportunities for quality improvement targeted at standardizing endoscopist written post-colonoscopy recommendations. Next steps include understanding patient and referring provider interpretation of written recommendations and how variation in recommendations affects follow-up and clinical outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)