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Colonoscopy
fears overcome when patients support
patients
Newswise — Patients who
have had a colonoscopy can play a
life-saving role by encouraging other
patients to follow through with their own
colorectal cancer screenings, according to
new research from the University of
Pennsylvania School of Medicine.
These peer coaches can
provide important information to combat
myths and fears that serve as barriers to
colonoscopy – issues patients say their
doctors often fail to address.
In a randomized trial,
clinicians in the Division of General
Internal Medicine studied patients who were
at increased risk of missing their scheduled
colon study appointment.
They found that those
who received telephone mentoring from a
trained “peer coach” were two times more
likely to keep their first colonoscopy
appointment than those who received an
educational brochure about the procedure in
the mail or received no peer or literature
support.
“This study addresses
an important gap in colorectal cancer
prevention in the United States – patients
who don’t follow through with their
appointments,” says lead author Barbara J.
Turner, MD, MSEd, Professor of Medicine and
Director of Penn’s General Medicine
Physician Scientist Fellowship.
“This is one of the
first studies to show that patients can help
other patients overcome barriers to getting
tests that can prevent this deadly disease.”
The findings will be published this month in
the Journal of General Internal Medicine.
Colorectal cancer is
the second most common cause of
cancer-related death in the United States,
but less than 60 percent of Americans over
the age of 50 have had a screening
colonoscopy or sigmoidoscopy in the past ten
years.
Even when patients
schedule appointments for these tests,
one-third of patients cancel, in part
because they have unanswered questions or
unfounded fears about the procedure or the
colon-cleansing preparation.
Turner and her
colleague Kevin Fosnocht, MD, Penn
Presbyterian Chief Quality and Patient
Safety Officer, ran a training program for
the five peer coaches, each of whom had
previously had a colonoscopy.
During the program, the
coaches learned about communication
strategies, the biology of colorectal
cancer, screening modalities and potential
barriers to colonoscopy.
The coaches then called
study patients within two weeks of their
appointment to offer education and
encouragement by following a scripted guide.
Patients in the
brochure group received pamphlets from the
American Cancer Society and the U.S. Centers
for Disease Control and Prevention.
Study patients were
mostly female and black, and compared with
other patient groups, patients randomized to
the peer coach support group were more
likely to be Medicaid insured and have low
primary care visit adherence.
Among those who
received the telephone peer counseling,
nearly 70 percent kept their colonoscopy
appointment. Turner and colleagues estimated
that without peer support, only 52 percent
of patients with similar characteristics
would have attended their appointment.
Only 58 percent of
those who received the brochure attended
their appointment, while only 48 percent
patients who refused any study support
attended.
During follow-up phone
calls, 80 percent of patients in the peer
coach arm of the study rated their coaching
as “very helpful,” and most appreciated
hearing about another patient’s experience
and commented on their need for more
information than was provided by their
physician.
Those findings mirror
previous Penn research, published in the
August 2007 issue of the Journal of Family
Practice, which identified communications
shortfalls among doctors discussing
colonoscopy with patients.
Although most doctors
studied explained the value of screening to
patients, few touched on issues concerning
insurance coverage for the procedure – a
barrier for many patients – dietary issues
before the procedure, or risks of the
procedure.
Some doctors used
colloquial terms that could be regarded as
crude – “It’s basically Liquid Plumber for
your bowels,” for instance, when explaining
the prep for the procedure – or too
technical for patients to understand. Still
others provided information that was simply
incorrect.
Other study sites for
the peer coaching study included the Penn
State College of Medicine and Princeton
University. Funding for the research was
provided by Penn Presbyterian Medical
Center’s Bach Fund.
PENN Medicine is a $3.5
billion enterprise dedicated to the related
missions of medical education, biomedical
research, and excellence in patient care.
PENN Medicine consists of the University of
Pennsylvania School of Medicine (founded in
1765 as the nation's first medical school)
and the University of Pennsylvania Health
System.
Penn's School of
Medicine is currently ranked #3 in the
nation in U.S.News & World Report's survey
of top research-oriented medical schools;
and, according to most recent data from the
National Institutes of Health, received over
$379 million in NIH research funds in the
2006 fiscal year.
Supporting 1,400
fulltime faculty and 700 students, the
School of Medicine is recognized worldwide
for its superior education and training of
the next generation of physician-scientists
and leaders of academic medicine.
The University of
Pennsylvania Health System includes three
hospitals — its flagship hospital, the
Hospital of the University of Pennsylvania,
rated one of the nation’s “Honor Roll”
hospitals by U.S.News & World Report;
Pennsylvania Hospital, the nation's first
hospital; and Penn Presbyterian Medical
Center — a faculty practice plan; a
primary-care provider network; two
multispecialty satellite facilities; and
home care and hospice.
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