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Canadian Journal of Gastroenterology
Volume 24 (2010), Issue 11, Pages 656-660
Original Article

Comparing Patient and Endoscopist Perceptions of the Colonoscopy Indication

Maida J Sewitch,1,2 Dara Stein,2 Lawrence Joseph,2,3 Alain Bitton,1,4 Robert J Hilsden,5 Linda Rabeneck,6 Lawrence Paszat,7,8 Jill Tinmouth,9 and Mary Anne Cooper10

1Department of Medicine, McGill University, Canada
2Division of Clinical Epidemiology, The Research Institute of the McGill University Health Centre, Canada
3Department of Epidemiology and Biostatistics, McGill University, Canada
4Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
5Departments of Medicine/Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
6Department of Medicine, University of Toronto, Toronto, Canada
7Radiation Oncology Research Unit, Department of Oncology, Queen’s University, Canada
8Kingston Regional Cancer Centre, Department of Community Health and Epidemiology, Queen’s University, Kingston, Canada
9Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
10Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

Received 5 November 2009; Accepted 15 February 2010

Copyright © 2010 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Determining whether a colonoscopy is performed for screening or nonscreening purposes can facilitate clinical practice and research. However, there is no simple method to determine the colonoscopy indication using patient medical files or health administrative databases.

OBJECTIVE: To determine patient-endoscopist agreement on the colonoscopy indication.

METHODS: A cross-sectional study was conducted among staff endoscopists and their patients at seven university-affiliated hospitals in Montreal, Quebec. The study participants were 50 to 75 years of age, they were able to understand English or French, and were about to undergo colonoscopy. Self- (endoscopist) and interviewer-administered (patient) questionnaires ascertained information that permitted classification of the colonoscopy indication. Patient colonoscopy indication was defined as the following: perceived screening (routine screening, family history, age); perceived nonscreening (follow-up); medical history that implied nonscreening; and a combination of the three preceding indications. Agreement between patient and endoscopist indications was measured using concordance and Kappa statistic.

RESULTS: In total, 702 patients and 38 endoscopists participated. The three most common reasons for undergoing colonoscopy were routine screening/regular check-up (33.8%), follow-up to a previous problem (30.2%) and other problem (24.6%). Concordance (range 0.79 to 0.85) and Kappa (range 0.58 to 0.70) were highest for perceived nonscreening colonoscopy. Recent large bowel symptoms accounted for 120 occurrences of disagreement in which the patient perceived a nonscreening colonoscopy while the endoscopist perceived a screening colonoscopy.

CONCLUSIONS: Patient self-report may be an acceptable means for rapidly assessing whether a colonoscopy is performed for screening or nonscreening purposes. Delivery of patient-centred care may help patients and endoscopists reach a shared understanding of the reason for colonoscopy.