The movement to increase colorectal cancer screening in the United States has gained steam over the past few years, but CRC remains a leading cause of cancer death. Whether due to lack of awareness, access or in many cases fear, there remains a large unscreened population of people. Timothy Miller, MD, of Lubbock (Texas) Digestive Disease Associates and South Plains Endoscopy Center, shares three ways gastroenterologists can help ease patient fears and get more people screened.
1. Minimize the role prep has to play. Most of the horror stories patients hear about colonoscopy focus on the day before. "The prep is the worst part, but it is never as bad as they think," says Dr. Miller. Though all preparations will flush out the bowels, there are many different options now.
Dr. Miller has his patients take three laxative pills followed by two 10-ounce bottles of laxatives. "The two 10-ounce bottles are less than two coke cans," he says. Explain to patients how simple it is to drink the low-volume preparation and assure them the experience, while not pleasant, is nothing they cannot handle.
2. Explain how anesthesia works. Most patients prefer to be under anesthesia for colonoscopy, though this is not necessary. Despite the minimal risk anesthesia during colonoscopy poses, many patients, particularly those that have never been sedated, are afraid of the process. Anesthesia is administered by an anesthesiologist or CRNA; explain to the patient that these people are trained professionals. "I reassure my patients that they will feel drowsy and almost instantly fall asleep," says Dr. Miller. "Propofol wears off very quickly. After the procedure patents will be awake and home within the hour." Patients can also be reassured that they will feel nothing when under the anesthetic.
3. Emphasize the benefits. Naturally, patients focus on the short-term hassle and embarrassment of undergoing a colonoscopy and not on the long-term benefits. Colonoscopy is the gold standard of CRC screening because it can detect and remove polyps and pre-cancerous lesions. Gastroenterologists can explain to patients that this test, which occurs on a single day, will nearly eliminate the possibility of developing colorectal cancer.
While some GI practices may rely on primary care physicians to explain how colonoscopy works, it is helpful for gastroenterologists to take the time to do so with patients. "Most of my colonoscopy patients come from primary care physician referrals. They do a great job," says Dr. Miller. "Their job is to send them to me and it is my job to quell the patient's fears."