Although colorectal cancer screening techniques can decrease the incidence of colon cancer by 75 percent, multiple studies published in medical literature cite a broad range of reasons patients forgo colorectal cancer screening. Stacey Weiland, MD, discusses five ways GI physicians can encourage patients to undergo screening.
1. Work as a team with primary care physicians. A majority of the time, GI physicians are seeing patients for the first time on the day of the colorectal cancer screening. Since there is no time prior to the day for GI physicians to sit down with patients and clearly explain the bowel prep process, address their concerns about discomfort and cost and the importance of undergoing screening, GI physicians must work with primary care physicians to bring patients up to speed on all those issues as soon as possible.
"If an internist struggles with having the time to discuss the patient's screening, the GI physician and internist should work together to bring the patient to the GI office for that discussion," Dr. Weiland says. "That would increase the chances of the patient completing their screening."
2. Understand patients' concerns. A significant number of studies have been published on the subject of low completion rates for screening and why patients choose not to undergo colorectal cancer screening. One such study conducted at the University of Colorado, Denver, evaluated the characteristics of patients who chose to forgo screening and their reasons for doing so. For example, women were more likely to not show up for their colonoscopies, and those patients generally expressed fear or embarrassment as the reason.
"I receive a lot of patients requesting a female gastroenterologist, and that helps ease their fear or embarrassment quite a bit," Dr. Weiland says.
3. Educate patients on cost. GI physicians should do as much as they can to address patient concerns about colorectal cancer screening through patient education. For example, Dr. Weiland says many patients seem to be concerned with the cost of undergoing screening.
"As long as those patients meet certain criteria, the screenings can be covered by insurance companies," she says. "The patient must be over 50 in order to quality, or if the patient has a family member who has had colon cancer or had polyps removed, they can undergo screening 10 years before the age that family member was diagnosed. For the most part, many modalities are covered by insurance."
Dr. Weiland adds insurance companies will also generally pay for patients who have concerning symptoms, including a change in bowel habits (new constipation or diarrhea), blood in the stool, abdominal pain and weight loss.
4. Explain the varying modalities for colorectal cancer screening. Dr. Weiland says patients may be more willing to undergo a colorectal cancer screening if they are made aware of the options available to them. Currently, there are five major modalities: colonoscopy, fecal occult blood testing, virtual colonoscopy, flexible sigmoidoscopy and barium enema. Another option has yet to be approved by the FDA for safety and efficacy: capsule endoscopy. Each modality utilizes different methods and has different outcomes.
"For example, some modalities, such as fecal occult blood testing plus flexible sigmoidoscopy or barium enema, don't require conscious sedation, so patients who undergo these types of screenings don't have to be driven home by a friend or family member and are at a lower risk of experiencing colon perforation," Dr. Weiland says.
5. Help patients understand the importance of proper bowel prep. Much to the chagrin of patients, bowel prep is an unavoidable part of the colorectal screening process and frequently causes patients to not complete screenings. Since bowel prep is a necessary evil in this process, Dr. Weiland says GI physicians should clearly explain to patients the importance of proper bowel prep and what to expect during the bowel prep process.
"Unfortunately, there is no way around bowel prep because it's necessary for all of the screening modalities," Dr. Weiland says. "If there is stool in the colon, the GI physician could miss a polyp."
Dr. Weiland adds there are several strategies GI physicians can suggest to patients to make the bowel prep process more tolerable. "When I worked on-call and received phone calls from patients about bowel prep, I often suggested to put the prep in the fridge, drink with a straw or choose a prep that comes in different flavorings to make it more palatable," she says.
1. Work as a team with primary care physicians. A majority of the time, GI physicians are seeing patients for the first time on the day of the colorectal cancer screening. Since there is no time prior to the day for GI physicians to sit down with patients and clearly explain the bowel prep process, address their concerns about discomfort and cost and the importance of undergoing screening, GI physicians must work with primary care physicians to bring patients up to speed on all those issues as soon as possible.
"If an internist struggles with having the time to discuss the patient's screening, the GI physician and internist should work together to bring the patient to the GI office for that discussion," Dr. Weiland says. "That would increase the chances of the patient completing their screening."
2. Understand patients' concerns. A significant number of studies have been published on the subject of low completion rates for screening and why patients choose not to undergo colorectal cancer screening. One such study conducted at the University of Colorado, Denver, evaluated the characteristics of patients who chose to forgo screening and their reasons for doing so. For example, women were more likely to not show up for their colonoscopies, and those patients generally expressed fear or embarrassment as the reason.
"I receive a lot of patients requesting a female gastroenterologist, and that helps ease their fear or embarrassment quite a bit," Dr. Weiland says.
3. Educate patients on cost. GI physicians should do as much as they can to address patient concerns about colorectal cancer screening through patient education. For example, Dr. Weiland says many patients seem to be concerned with the cost of undergoing screening.
"As long as those patients meet certain criteria, the screenings can be covered by insurance companies," she says. "The patient must be over 50 in order to quality, or if the patient has a family member who has had colon cancer or had polyps removed, they can undergo screening 10 years before the age that family member was diagnosed. For the most part, many modalities are covered by insurance."
Dr. Weiland adds insurance companies will also generally pay for patients who have concerning symptoms, including a change in bowel habits (new constipation or diarrhea), blood in the stool, abdominal pain and weight loss.
4. Explain the varying modalities for colorectal cancer screening. Dr. Weiland says patients may be more willing to undergo a colorectal cancer screening if they are made aware of the options available to them. Currently, there are five major modalities: colonoscopy, fecal occult blood testing, virtual colonoscopy, flexible sigmoidoscopy and barium enema. Another option has yet to be approved by the FDA for safety and efficacy: capsule endoscopy. Each modality utilizes different methods and has different outcomes.
"For example, some modalities, such as fecal occult blood testing plus flexible sigmoidoscopy or barium enema, don't require conscious sedation, so patients who undergo these types of screenings don't have to be driven home by a friend or family member and are at a lower risk of experiencing colon perforation," Dr. Weiland says.
5. Help patients understand the importance of proper bowel prep. Much to the chagrin of patients, bowel prep is an unavoidable part of the colorectal screening process and frequently causes patients to not complete screenings. Since bowel prep is a necessary evil in this process, Dr. Weiland says GI physicians should clearly explain to patients the importance of proper bowel prep and what to expect during the bowel prep process.
"Unfortunately, there is no way around bowel prep because it's necessary for all of the screening modalities," Dr. Weiland says. "If there is stool in the colon, the GI physician could miss a polyp."
Dr. Weiland adds there are several strategies GI physicians can suggest to patients to make the bowel prep process more tolerable. "When I worked on-call and received phone calls from patients about bowel prep, I often suggested to put the prep in the fridge, drink with a straw or choose a prep that comes in different flavorings to make it more palatable," she says.