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Post-polypectomy Guideline Adherence: Importance of Belief in Guidelines, Not Guideline Knowledge or Fear of Missed Cancer

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Abstract

Background

Adherence to post-polypectomy surveillance guideline recommendations is suboptimal. Surveillance is frequently over- and under-recommend, resulting in strained colonoscopy capacity, potential risks without expected benefits, and missed opportunities for colorectal cancer risk reduction.

Aims

To identify factors associated with adherence to post-polypectomy surveillance guidelines.

Methods

We conducted a three-phase study with a retrospective review of usual care post-polypectomy surveillance recommendations through medical chart abstraction (Phase I), prospective online physician survey (Phase II), and analysis of survey-based and other physician-based predictors of usual care surveillance recommendations (Phase III). Subjects included patients who underwent usual care colonoscopy 2011–2012 (Phases I and III) and gastroenterology (GI) attendings and fellows (Phases II and III). We identified rates of recommendations consistent with guideline adherence, surveillance overuse, and surveillance underuse based on usual care medical chart documentation and physician survey, as well as predictors of physician adherence to guidelines.

Results

We reviewed 640 patient charts for 28 survey respondents. Rates of usual practice recommendations consistent with guideline adherence, surveillance overutilization, and underutilization were 84, 13, and 3 %, respectively. At survey, 82 % of physicians were concerned about missed cancer. Eleven percentage believed that guidelines were not aggressive enough. GI trainees were 2.5 times more likely to issue guideline-adherent recommendations [OR 2.5, 95 % CI (1.5–4.2)]. Disagreement with guideline aggressiveness was independently associated with 40 % lower likelihood of adherence [OR 0.6, 95 % CI (0.4–0.8)].

Conclusions

Belief in the appropriate aggressiveness of guidelines and trainee position, but not fear of missed cancer or guideline knowledge, was associated with adherence to post-polypectomy surveillance guidelines.

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Acknowledgments

The project described was supported in part by Merit Review Award number 1 I01 HX001574-01A1 (Gupta, PI) from the United States Department of Veterans Affairs Health Services Research & Development Service of the VA Office of Research and Development. The views expressed in this article are those of the author(s) and do not necessarily represent the views of the Department of Veterans Affairs. Support was also provided in part by the NCI-funded consortium Population-Based Research Optimizing Screening through Personalized Regiments (PROSPR) through NIH/NCI Grant U54CA163308-01 (Singal, CO-I). We thank Drs. Kenneth R. McQuaid, Robert H. Lee, and John E. Pandolfino for reviewing and providing feedback on the physician survey.

Conflict of interest

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. University of Texas Southwestern Medical Center and Parkland Health and Hospital System, 5323 Harry Hines, K5.140A, Dallas, TX, 75390, USA

    Neha Patel

  2. University of Texas Houston, 1200 Pressler Street, Houston, TX, 77030, USA

    Liyue Tong

  3. Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr, MC 111D, San Diego, CA, 92161, USA

    Samir Gupta

  4. Division of Gastroenterology, Department of Internal Medicine, Moores Cancer Center, University of California San Diego, La Jolla, CA, USA

    Samir Gupta

  5. University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, E5.506, Dallas, TX, 75390-9066, USA

    Chul Ahn

  6. University of Texas Southwestern Medical Center and Parkland Health and Hospital System, 5959 Harry Hines Blvd, POB I Suite 420B, Dallas, TX, 75201 – 8887, USA

    Amit G. Singal

Authors
  1. Neha Patel
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  2. Liyue Tong
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  4. Amit G. Singal
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  5. Samir Gupta
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Corresponding author

Correspondence to Samir Gupta.

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Patel, N., Tong, L., Ahn, C. et al. Post-polypectomy Guideline Adherence: Importance of Belief in Guidelines, Not Guideline Knowledge or Fear of Missed Cancer. Dig Dis Sci 60, 2937–2945 (2015). https://doi.org/10.1007/s10620-015-3685-x

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  • DOI: https://doi.org/10.1007/s10620-015-3685-x

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