Cholecystectomy should be recommended to elderly patients after a first acute biliary complication. If not previously performed, ERCP should be offered as an alternative when surgery is contraindicated or refused.

BackgroundIntroducing shared decision making (SDM) in colorectal cancer (CRC) screening requires patients to acquire appropriate knowledge. We aimed to describe the knowledge attained by subjects with a family history of CRC.MethodsConsecutive patients attending the gastroenterology clinic for a CRC family history were invited to take part in a cross-sectional survey. Attitudes towards SDM, satisfaction with the information received, knowledge currently achieved, and relevant influencing factors were evaluated. Satisfaction and attitudes towards SDM were evaluated with Likert scale questions. Knowledge was surveyed with closed (80%) and open (20%) questions.ResultsOf the 160 patients, 42.7% were male and the median age was 51.8 years (interquartile range: 43.9-58.5). Most subjects favored SDM; only 12.8% (8.4-19.1%) favored passive attitudes. Satisfaction with the information received about what a colonoscopy is and why it is recommended was adequate in 83.1% (76.4-88.2%). Information about risks satisfied 62.9% (55-70.1%) and about alternatives to colonoscopy only 30.6% (23.8-38.3%). The benefits of screening were better known than its risks and alternatives. The CRC decrease associated with screening was known to 71.3% (63.7-77.8%), but only 38.5% (31.1-46.4%) knew that a reduced risk still exists. Just 21.2% (15.5-26.9%) could mention an alternative screening method to colonoscopy and only 42.5% (35-50.4%) were aware of any associated harm. On multivariate analysis, higher educational level and younger age of the attending physician were associated with higher knowledge scores.ConclusionSDM is considered favorably by most patients. Although information about the benefits of CRC screening is transmitted adequately, risks and alternatives should be better addressed.

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