Presentation Title: Low-risk Adenoma Surveillance Decision-making: Perspectives from Patients and Providers

Author Name(s): Jennifer K. Maratt, MD, MS

Author Department and School Affiliation: Department of Medicine, Indiana University School of Medicine; Richard L. Roudebush VA Medical Center; Regenstrief Institute, Inc.

Abstract:
Background: A large proportion of colonoscopies are performed for post-polypectomy surveillance. Data show that there is underuse of surveillance for high risk colon adenomas, but overuse for low-risk adenomas (LRAs). Overuse can be attributed to patient, provider, and system-level factors yet little is known about patients’ beliefs and understanding of colorectal cancer risk in the setting of LRAs. Endoscopists recommend future colonoscopies primarily based on polyp characteristics, not taking into account patient health status or preference. On the other hand, primary care providers (PCPs), who are aware of these factors, rarely deviate from endoscopists’ recommendations. The primary objective of this study is to obtain an in-depth understanding of the decision-making process for LRA surveillance from patient and provider perspectives.

Methods: Using semi-structured interviews, a total of 32 patients with a history of LRAs and 16 providers (PCPs and gastroenterologists) from Roudebush VA and Eskenazi will be interviewed. The following domains will be covered: risk communication, risk perception, and decision-making for LRA surveillance. A 3-phase approach, immersion, reduction, and interpretation, will be used to collect and analyze data.

Potential Impact: Understanding decision-making for LRA surveillance colonoscopy has the potential to inform future interventions targeted towards reducing overuse of this low-value service.