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Introduction and aims:
In Germany in October 2002 the screening-colonoscopy was introduced into the national programme for colorectal cancer prevention for asymptomatic subjects older than 55 years. The colonoscopy is an established low risk examination for symptomatic patients, but there is not enough literature about acceptance and satisfaction in asymptomatic patients (1,2,3). The study was designed to determine whether there are differences in men or women who participate in the screening-colonoscopy, how the patients were informed about the new prevention-strategy with the screening- colonoscopy and to analyze the acceptance of different bowel preparation in outpatients of 3 practices for gastroenterology in Germany.
Methods: 300 consecutive patients (3-5/2006 - 100 in each centre) were prospectively given a questionnaire and a prepaid envelope after the screening colonoscopy, with the request to complete the questionnaire at home and to send it back to the evaluating practice (1). Data was extracted from the questionnaire.
Results:
Out of 272 questionnaires (91%) a total of 263 questionnaires were included, because 9 were invaluable because of mistakes. Of these, 48% were male and 52% were female. We found no significant differences in the 3 centres, so the items were evaluated all together. The general practitioner did the main part of the work in informing patients about the screening-colonoscopy (m=79%; f=57%). Discussing about prevention strategies was more frequently relevant in gynaecologists (46%) than in urologists (10%). Patients informed themselves in advertising and media in 44% (m= 13%; f=31%). In the private surrounding of patients the colonoscopy is an open theme in 30% (multiple answers were possible). The bowel cleansing was done with Golytely RSS (Endofalk®) in 2 centres and with Phosphosoda (Fleet®) in l centre. 83% (m=90%; f=75%) were satisfied with the bowel cleansing procedure. 50% of male and 30% of female had no fear because of the examination. 44% of men and 53% of women were worrying about the result of the colonoscopy. Women (26%) had more fear about pain concerning the colonoscopy compared to men (14%). Patients felt well informed about the colonoscopy by the gastroenterologist (95%). They plan to talk free and easy about their colonoscopy with family members (83%) as well as with friends (88%) or at work (45% of employed patients). Patients who undergo screening-colonoscopy participate in other cancer screening programmes in nearly 90%.
Conclusion:
According to this evaluation the screening-colonoscopy is a well accepted method of cancer prevention in the German population in an outpatient setting in private practices of gastroenterology. In the society a bowel examination is not a taboo topic anymore. The Standard bowel cleansing procedures are well tolerated. However the screening Programme will only be successful in a long run, when general practitioners and specialized doctors are convinced of the effectiveness and importance of the screening-colonoscopy, and when they are willing to motivate their patients to choose this chance of cancer prevention.
Learning outcomes:
Motivation of patients for the screening-colonoscopy. Acceptance of bowel cleansing regimes.
References:
1. Hueppe D, Lemberg L, Feiten G: Effectiveness and patient tolerance of screening colonoscopy - first results. Z Gastroenterol 2004; 42: 591-8.
2. Sieg A, Theilmeier A: Results of coloscopy screening in 2005 - an internet based documentation. Dtsch Med Wochenschr 2006; 131:379-83.
3. Homa K: Acceptance of screening colonoscopy for the prevention of colorectal cancer. Ann Aca Med Stetin 2004, 50: 55-63.
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