Patient Preferences of a Resect and Discard Paradigm

Study Overview
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Brief Summary
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The investigators conducted a study Resect and Discard Diminutive Polyps: a new paradigm (IRB ID # 201105473) from September, 2011 to July, 2013. This study examined whether doctors performing colonoscopy are accurate enough at predicting histology of small colorectal polyps, such that these small polyps could be resected and discarded (instead of being sent to pathology). One of the main advantages of this approach is significant cost savings by reducing pathology costs associated with screening and surveillance colonoscopy. A disadvantage is that there is a 0.03% chance that small polyps contain cancer. There is no data regarding patient preferences toward this approach. The investigators therefore designed a patient survey to determine the patient's view toward this approach.

Detailed Description
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The American Society of Gastrointestinal Endoscopy (ASGE) published a review article on a new paradigm in colorectal cancer screening termed resect and discard. This new paradigm challenges the current practice of sending all colorectal polyps, regardless of appearance or size, to pathology for analysis. Resect and Discard describes a new approach in which small polyps could be removed, but be discarded instead of sent for pathology analysis. This is based on data showing that gastroenterologists can predict the pathology of small colorectal polyps with 80-90% accuracy, and that discarding small polyps would not alter surveillance recommendations. Neither the ASGE document nor published research, however, assessed patient attitudes toward this approach. This study surveyed patients prior to first time screening colonoscopy, in order to determine their preferences about the resect and discard approach; specifically would patients be willing to pay for pathology analysis of small colorectal polyps with their own money, and what factors influence their decision. We also inquired about factors that would influence their decision to pay/not pay pathology costs themselves.

Official Title
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Patient Preferences of a Resect and Discard Paradigm

Conditions
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Colonic Polyps

Intervention / Treatment
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* Other: Survey


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • Indication for colonoscopy is screening or routine polyp surveillance Exclusion Criteria: Indication for colonoscopy other than screening or surveillance Colon cancer identified at time of colonoscopy Known polyposis syndrome, or polyposis identified at colonoscopy

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: Survey|Standard Gamble Survey|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants willing to pay out of pocket for pathology costs when a diminutive polyp is found. | This outcome is measured in percentage. | June, 2012 to March, 2014: up to 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The factors that influence patients' decisions to pay or not pay for pathology costs with their own money. | These factors were measured using univariate analysis with generation of odds ratios and 95% confidence intervals. | June, 2012 to March, 2014: up to 2 years |