Journal of General Internal Medicine

, Volume 8, Issue 3, pp 120–125

Screening flexible sigmoidoscopy

Patient attitudes and compliance
  • Bruce D. McCarthy
  • Mark A. Moskowitz
Original Articles

Abstract

Objective: To measure patients’ expectations and attitudes about screening flexible sigmoidoscopy and their discomfort during the procedure, and to identify factors affecting compliance among patients scheduled for sigmoidoscopy.

Design: Patient survey at the time sigmoidoscopy was ordered and again one week after the procedure was performed.

Setting: An academic general internal medicine practice.

Patients: 105 consecutive patients scheduled for screening flexible sigmoidoscopy.

Main results: Seventy-five percent of patients (79/105) scheduled for sigmoidoscopy complied with the procedure. Compliance was higher among men and among patients who had family histories of colon cancer. Although many patients experienced moderate to extreme embarrassment (27%), discomfort (42%), and pain (31%), patients experienced less embarrassment (p=0.03) and pain (p=0.02) than they had expected. Patients aged 65 years and older were twice as likely as younger ones (52% versus 25%) to experience moderate to extreme pain (p=0.04). Only 1.4% of patients reported that they would probably not have the test again.

Conclusion: Although flexible sigmoidoscopy is an uncomfortable procedure for some patients, especially those aged 65 and older, in general it is not as bad as patients expect and most would have the test again. Therefore, rather than assuming sigmoidoscopy is too uncomfortable for all patients to tolerate as a screening test, clinicians should inform their patients about the potential benefits and risks of sigmoidoscopy and about what the patient can expect during the procedure, thus enabling the patient to make an informed decision about whether to undergo screening sigmoidoscopy.

Key words

cancer screening colorectal neoplasms sigmoidoscopy patient compliance 

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References

  1. 1.
    American Cancer Society. Summary of current guidelines for the cancer-related checkup: recommendations. New York: American Cancer Society, 1989.Google Scholar
  2. 2.
    National Cancer Institute. Working guidelines for early cancer detection: rationale and supporting evidence to decrease mortality. Bethesda, MD: National Cancer Institute, 1987.Google Scholar
  3. 3.
    American College of Physicians, Clinical Efficacy Assessment Project. Screening for colorectal cancer. Philadelphia: American College of Physicians, 1990.Google Scholar
  4. 4.
    Woo B, Woo B, Cook EF, Weisberg M, Goldman L. Screening procedures in the asymptomatic adult. Comparison of physicians’ recommendations, patients’ desires, published guidelines, and actual practice. JAMA. 1985;254:1480–4.PubMedCrossRefGoogle Scholar
  5. 5.
    McPhee SJ, Richard RJ, Solkowitz SN. Performance of cancer screening in a university general internal medicine practice: comparison with the 1980 American Cancer Society guidelines. J Gen Intern Med. 1986;1:275–81.PubMedCrossRefGoogle Scholar
  6. 6.
    Rodney WM, Beaber RJ, Johnson R, Quan M. Physician compliance with colorectal cancer screening (1978–1983): the impact of flexible sigmoidoscopy. J Fam Pract. 1985;20:265–9.PubMedGoogle Scholar
  7. 7.
    American Cancer Society. 1989 survey of physicians’ attitudes and practices in early cancer detection. CA. 1990;40:77–101.CrossRefGoogle Scholar
  8. 8.
    Frame PS. A critical review of adult health maintenance. Part 3: Prevention of cancer. J Fam Pract. 1986;22:511–20.PubMedGoogle Scholar
  9. 9.
    Frame PS. Screening flexible sigmoidoscopy: is it worthwhile? An opposing view. J Fam Pract. 1987;25:604–7.PubMedGoogle Scholar
  10. 10.
    Bohlman TW, Katon RM, Lipshutz GR, McCool MF, Smith FW, Melnyk CS. Fiberoptic pansigmoidoscopy: an evaluation and comparison with rigid sigmoidoscopy. Gastroenterology. 1977;72:644–9.PubMedGoogle Scholar
  11. 11.
    Marks G, Boggs HW, Castro AF, Gathright JB, Ray JE, Salvati E. Sigmoidoscopic examinations with rigid and flexible fiberoptic sigmoidoscopes in the surgeon’s office: a comparative prospective study of effectiveness in 1,012 cases. Dis Colon Rectum. 1979;22:162–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Winnan G, Berci G, Panish J, Talbot TM, Overholt BF, McCallum RW. Superiority of the flexible to the rigid sigmoidoscope in routine proctosigmoidoscopy. N Engl J Med. 1980;302:1011–2.PubMedCrossRefGoogle Scholar
  13. 13.
    Grobe JL, Kozarek RA, Sanowski RA. Flexible versus rigid sigmoidoscopy: a comparison using an inexpensive 35-cm flexible proctosigmoidoscope. Am J Gastroenterol. 1983;78:569–71.PubMedGoogle Scholar
  14. 14.
    Dubow RA, Katon RM, Benner KG, van Dijk CM, Koval G, Smith FW. Short (35-cm) versus long (60-cm) flexible sigmoidoscopy: a comparison of findings and tolerance in asymptomatic patients screened for colorectal neoplasia. Gastrointest Endosc. 1985;31:305–8.PubMedGoogle Scholar
  15. 15.
    Zucker GM, Madura MJ, Chmiel JS, Olinger EJ. The advantages of the 30-cm flexible sigmoidoscope over the 60-cm flexible sigmoidoscope. Gastrointest Endosc. 1984;30:59–64.PubMedCrossRefGoogle Scholar
  16. 16.
    Winawer SJ, Leidner SD, Boyle C, Kurtz RC. Comparison of flexible sigmoidoscopy with other diagnostic techniques in the diagnosis of rectocolon neoplasia. Dig Dis Sci. 1979;24:277–81.PubMedCrossRefGoogle Scholar
  17. 17.
    Sarles HE Jr, Sanowski RA, Haynes WC, Bellapravalu S. The long and short of flexible sigmoidoscopy: does it matter? Am J Gastroenterol. 1986;81:369–71.PubMedGoogle Scholar
  18. 18.
    Traul DG, Davis CB, Pollock JC, Scudamore HH. Flexible fiberoptic sigmoidoscopy—the Monroe Clinic experience. A prospective study of 5,000 examinations. Dis Colon Rectum. 1983;26:161–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Winawer SJ, Miller C, Lightdale C, et al. Patient response to sigmoidoscopy. A randomized, controlled trial of rigid and flexible sigmoidoscopy. Cancer. 1987;60:1905–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Fleischer DE, Goldberg SB, Browning TH, et al. Detection and surveillance of colorectal cancer. JAMA. 1989;261:580–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Rodney WM. Screening flexible sigmoidoscopy: is it worthwhile? An affirmative view. J Fam Pract. 1987;25:601–4.PubMedGoogle Scholar
  22. 22.
    Sleby JV, Friedman GD. Sigmoidoscopy in the periodic health examination of asymptomatic adults. JAMA. 1989;261:595–601.Google Scholar
  23. 23.
    Canadian Task Force on the Periodic Health Examination. The periodic health examination: 2. 1989 update: early detection of colorectal cancer and problem drinking. Can Med Assoc J. 1989;141:209–16. [Erratum, Can Med Assoc J. 1989;141:1126.]Google Scholar
  24. 24.
    Thompson RS, Michnich ME, Gray J, Friedlander L, Gilson B. Maximizing compliance with hemoccult screening for colon cancer in clinical practice. Med Care. 1986;24:904–14.PubMedCrossRefGoogle Scholar
  25. 25.
    Burack RC, Liang J. The early detection of cancer in the primary-care setting: factors associated with the acceptance and completion of recommended procedures. Prev Med. 1987;16:739–51.PubMedCrossRefGoogle Scholar
  26. 26.
    Macrae FA, St. John DJ, Ambikapathy A, Sharpe K, Garner JF. Factors affecting compliance in colorectal cancer screening. Results of a study performed in Ballarat. Med J Aust. 1986;144:621–3.PubMedGoogle Scholar
  27. 27.
    Sandler RS, DeVellis BM, Blalock SJ, Holland KL. Participation of high-risk subjects in colon cancer screening. Cancer. 1989;63:2211–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Blalock SJ, DeVellis BM, Sandler RS. Participation in fecal occult blood screening: a critical review. Prev Med. 1987;16:9–18.PubMedCrossRefGoogle Scholar
  29. 29.
    Becker MH, Maiman LA. Sociobehavioral determinants of compliance with health and medical care recommendations. Med Care. 1975;13:10–24.PubMedCrossRefGoogle Scholar
  30. 30.
    Hahn DL. Feasibility of sigmoidoscopic screening for bowel cancer in a primary care setting. J Am Board Fam Pract. 1989;2:25–9.PubMedGoogle Scholar
  31. 31.
    Bat L, Pines A, Ron E, Niv Y, Arditi E, Shemesh E. A community-based program of colorectal screening in an asymptomatic population: evaluation of screening tests and compliance. Am J Gastroenterol. 1986;81:647–51.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 1993

Authors and Affiliations

  • Bruce D. McCarthy
    • 1
  • Mark A. Moskowitz
  1. 1.Center for Clinical Effectiveness, NCP-400Henry Ford HospitalDetroit

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