High colonoscopy demand could mean low quality colorectal cancer screening

2012-03-13 18:07
A new survey shows some doctors are stressed over high demand for colonoscopies.

A survey shows doctors feel pushed to perform high volumes of colonoscopies in findings have implications for gastroenterologists, ancillary staff and patients. Results of surveys from gastroenterologists found 92% of 1000 doctors surveyed feel the pressure of performing high volumes of the colon cancer screening tests that could mean low quality colorectal cancer screening.

Researchers from The Mount Sinai Hospital / Mount Sinai School of Medicine conducted surveys of doctors who responded that the demand for performing colonoscopies has resulted in inability to perform adequate pre-procedure patient assessments, premature discharge after the procedure that requires sedation, deviation from ‘usual practices’, not enough staff, too few beds to accommodate patient recovery time, excessive work and higher levels of stress.

Interestingly, the survey results are just in time for colorectal cancer awareness month when news media resources are filled with articles urging the public to get their colonoscopy.

The study, published in the journal Gastrointestinal Endoscopy, surveyed 5,739 members of the ASGE who were asked 40 questions about how they’ve observed their colleagues, how their practice facility operates and demographic and practice characteristics. Among the surveys sent out, 1073 physicians responded.

The findings showed:

  • 13 percent of doctors thought they had insufficient time for an assessment for a colonoscopy procedure.
  • 7.7 percent thought they routinely lacked enough time to complete an examination.
  • 47.8 percent of saw a colleague vary from their usual practice patterns within the past 3-years because of pressure to produce.
  • 42 percent found inadequacies in their practice, such as too few beds in recovery and not enough rooms to do procedures.
  • 77.8 percent thought their workload was excessive.

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On a more positive note, 97 percent of gastroenterologists responding to the survey thought they delivered good medical care equal to or better than 3-years ago, though 78.5 percent said work-related stress has increased in the past three years. Eighty-one percent of docs said they’re working a lot harder for their money, compared to the past.

Lawrence B. Cohen, MD, lead study author and an Associate Clinical Professor of Gastroenterology at Mount Sinai said in a press release, "Balancing quantity and quality is an issue that needs to be addressed in order to ensure the continued success of colon cancer prevention programs." He explains at Mount-Sinai, colonoscopies are scheduled in half-day blocks, periodic retraining is offered and adequate bowel cleansing is a focus so physicians can clearly view the intestines for any abnormalities.

The surveys show doctors performing the colon cancer screening tests, recommended for adults over age 50, feel pushed due to the high volume demand for colonoscopy. High volume demand for colonoscopy could mean a lower quality colorectal cancer screening.

Source:
Gastrointestinal Endoscopy
"Is production pressure jeopardizing the quality of colonoscopy? A survey of U.S. endoscopists' practices and perceptions'
Matthew J. Whitson, et al.
March, 2012

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