Clinical Trial: Patient Preferences of a Resect and Discard Paradigm

Study Status: Completed
Recruit Status: Completed
Study Type: Observational

Official Title: Patient Preferences of a Resect and Discard Paradigm

Brief Summary: 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 Summary:

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.

Sponsor: Washington University School of Medicine

Current Primary Outcome: Number of participants willing to pay out of pocket for pathology costs when a diminutive polyp is found. [ Time Frame: June, 2012 to March, 2014: up to 2 years ]

Original Primary Outcome: Same as current

Current Secondary Outcome: The factors that influence patients' decisions to pay or not pay for pathology costs with their own money. [ Time Frame: June, 2012 to March, 2014: up to 2 years ]

Original Secondary Outcome: Same as current

Information By: Washington University School of Medicine

Dates:
Date Received: November 19, 2014
Date Started: June 2012
Date Completion:
Last Updated: May 10, 2017
Last Verified: May 2017