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Tuesday, March 21, 2017

Do patients and their physicians remember the same conversation about colorectal cancer screening? Not always, according to a multicenter study that evaluated what both parties took away from these encounters. Immediately after an office visit during which primary care providers were instructed to discuss CRC screening, well-educated patients and their doctors disagreed about 20% of the time on whether screening for cancer was even discussed or recommended, according to a study presented at the 2017 Gastrointestinal Cancers Symposium. Felice Schnoll-Sussman, M.D., shared her experience with the topic with Gastroenterlogy & Endoscopy News. Read the full article here.

Felice Schnoll-Sussman, M.D.Felice Schnoll-Sussman, M.D. “Let’s be honest. Very few patients come to a doctor’s office and truly want to have a screening colonoscopy,” Dr. Schnoll-Sussman said. 

When people approach middle age, they are usually presented with a list of screening tests to consider. These choices are often presented to them by a primary care provider, in very busy practices, who may not have ample time to adequately go through all the options.

Dr. Schnoll-Sussman said she “deals with this situation” by reviewing the screening options and emphasizing that colonoscopy allows her to identify premalignant polyps that, when removed completely, can essentially eliminate a patient’s risk for CRC.“In addition, guidelines from the different GI societies may differ in the strength of the recommendations for the different tests. When it comes to colonoscopy in particular, there are test-specific issues regarding preparation that also need to be reviewed carefully for optimal outcomes,” Dr. Schnoll-Sussman added. “Consequently, it is not difficult to understand why there could be a discrepancy between what the doctor believes they discussed and what the patient remembers.”

Dr. Schnoll-Sussman said she tells her patients: “This is very different from other screening tests that may only detect cancer after it is already present.’ This subtle mindset difference can really help to motivate a patient to be compliant with colon cancer screening and also focuses patients more clearly on the conversation.”

She also attempts to individualize the screening options for her patients.

“There are just some patients who do not want to have a colonoscopy. In that setting, shared decision making is essential,” she said. “Without overwhelming a patient, try to describe the different options available to them. Allowing a patient to play a role in the decision can be empowering. Understanding options, the importance of the testing, the potential risks and benefits—this is all part of the process of making sure I have a well-informed patient. As the saying goes, ‘An educated consumer is the best customer.’”