Most Patients Forget Colonoscopy Results as Time Goes By

Kathleen Louden

October 16, 2015

CHICAGO — Patient recall of colonoscopy findings and follow-up procedures fades quickly, according to a new study.

"Most patients were not able to recall the number of polyps detected if the colonoscopy was performed 2 years earlier, even if they recalled having polyps," said study investigator Mark Tarakji, MD, a surgical resident at the St. John Hospital and Medical Center in Detroit.

In fact, more than 1 year after colonoscopy, less than 40% of patients remembered whether they had polyps removed, and by 4 years, 72% of patients could not remember when the procedure was performed.

This study was prompted when principal investigator Amer Alame, MD, also from St John Hospital and Medical Center, noticed a wide range of answers when he asked patients if they had ever undergone colonoscopy, according to an American College of Surgeons (ACS) news release.

These results indicate that surgeons and other physicians performing colonoscopies should examine previous endoscopy reports before making clinically significant decisions, the investigators report.

Dr Tarakji presented the study results here at the ACS Clinical Congress 2015.

All 200 randomly selected patients were surveyed by telephone and asked to recall the approximate date of their most recent colonoscopy and the results, including the presence and number of polyps detected. The patients were classified into groups of 50 by time since colonoscopy: 2 months, 1 year, 2 years, and 4 years.

The investigators then compared patient recall with endoscopic documentation in electronic medical records.

Recall of specific colonoscopy findings was poor in many cases.

Accurate recall of a diagnosis of polyps fell from 65.2% of patients in the 2-month group to 37.5% in the 4-year group.

The approximate date of the most recent colonoscopy (within 6 months) was recalled accurately by only 14 (28%) of the 50 patients who underwent colonoscopy 4 years earlier.

Eight patients (4%) recalled a diagnosis of diverticulitis, but there was no evidence of this diagnosis in their medical records, Dr Tarakji reported.

And one patient who had undergone colonoscopy 2 months earlier had no recollection of it, he added.

Table. Recall by Time Since Most Recent Colonoscopy

Accurate Recall 2 Months, % 1 Year, % 2 Years, % 4 Years, %
Month and year of previous procedure 94.0 42.0 30.0 28.0
Diagnosis of polyps 65.2 31.6 35.7 37.5
Number of polyps detected 39.1 10.5 7.1 6.2

 

These findings are of concern because the recommended interval for colonoscopy follow-up differs, depending on the number and type of polyps detected during the previous examination, according to guidelines from the US Multi-Society Task Force on Colorectal Cancer (Gastroenterology. 2012;143:844-857).

"Patients' recollection of colonoscopy becomes increasingly suspect with time. It's worth taking a little extra time to obtain the records, and not rely strictly on the patient's recall," said session moderator Neil Hyman, MD, who is chair of the ACS advisory council for colon and rectal surgery.

"A lot of patients get colonoscopies that they don't need because they can't remember when they had the last one," he told Medscape Medical News. "Other patients may miss a needed colonoscopy, which can have adverse health consequences."

What Surgeons Can Do to Help

Dr Hyman said he agrees with the recommendation that the endoscopist obtain a patient's previous colonoscopy report before making clinically significant decisions.

Other recommendations to improve or offset patient recall include repeating important information to the patient after recovery from the procedure, giving the patient documentation of the results to take home and file, and sending a copy of the colonoscopy report to the patient's primary care provider.

Typically, endoscopists do not send the report unless the primary care physician requests it, Dr Alame explained in the news release. "But I know of centers that are being proactive about it and already doing this."

Although Dr Tarakji's team did not study the reasons for poor recall, Dr Hyman said that several factors could play a role, even in the era of readily available electronic medical records. Patients might not have received a printout of their results or they might have changed primary care physicians or moved to another area and not received their colonoscopy reminder.

In addition, the anesthetic used for the colonoscopy might alter what the patient remembers about the procedure, Dr Hyman pointed out.

When asked about the anesthetic used during colonoscopy in the study, Dr Tarakji reported that they administered propofol, fentanyl, and sometimes midazolam.

"We've switched to propofol from fentanyl and [meperidine]," said session discussant David Margolin, MD, from Ochsner Medical Center in New Orleans. "And we find that people are leaving the endoscopy suite [cognitively] clearer."

He asked whether the investigators had evaluated the correlation between poor recall and older age. Dr Tarakji said they have not yet looked at demographics in this way.

Dr Tarakji, Dr Alame, Dr Hyman, and Dr Margolin have disclosed no relevant financial relationships.

American College of Surgeons (ACS) Clinical Congress 2015. Presented October 8, 2015.

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