Endoscopic surveillance for Barrettʼs oesophagus: the patientsʼ perspective

Cooper, Sheldon C.; Elagib, Amul; Dar, Sadaf; Mohammed, I; Nightingale, Peter; Murray, Iain A.; Cooper, Barrett R.; Trudgill, Nigel

doi:10.1097/meg.0b013e328318ed2d

Cited by 28 publications

(47 citation statements)

References 23 publications

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“…However, this discussion should also mention the lack of randomised controlled data to prove the benefits of surveillance, and clinicians must also emphasise to the patient that the actual risk of death from oesophageal cancer is small. Furthermore, the disadvantages of endoscopy surveillance should also be discussed, including the small risks of the procedure26 and the associated psychological morbidity 137. For example, in an American study conducted in a population of Veterans with a diagnosis of Barrett's, more than half of the patients missed their follow-up endoscopy, suggesting that not all patients are willing to adhere to surveillance programmes 138.…”

Section: Practicalities Of Endosopic Surveillancementioning

confidence: 99%

British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus

Fitzgerald

Pietro

Ragunath

et al. 2013

Gut

1,183

1,297

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These guidelines provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was followed to provide a methodological strategy for the guideline development. A systematic review of the literature was performed for English language articles published up until December 2012 in order to address controversial issues in Barrett's oesophagus including definition, screening and diagnosis, surveillance, pathological grading for dysplasia, management of dysplasia, and early cancer including training requirements. The rigour and quality of the studies was evaluated using the SIGN checklist system. Recommendations on each topic were scored by each author using a five-tier system (A+, strong agreement, to D+, strongly disagree). Statements that failed to reach substantial agreement among authors, defined as >80% agreement (A or A+), were revisited and modified until substantial agreement (>80%) was reached. In formulating these guidelines, we took into consideration benefits and risks for the population and national health system, as well as patient perspectives. For the first time, we have suggested stratification of patients according to their estimated cancer risk based on clinical and histopathological criteria. In order to improve communication between clinicians, we recommend the use of minimum datasets for reporting endoscopic and pathological findings. We advocate endoscopic therapy for high-grade dysplasia and early cancer, which should be performed in high-volume centres. We hope that these guidelines will standardise and improve management for patients with Barrett's oesophagus and related neoplasia. PURPOSE AND METHODSThe purpose of this guideline is to provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. This document is therefore aimed at gastroenterologists, physicians and nurse practitioners, as well as members of multidisciplinary teams (MDTs; surgeons, radiologists, pathologists), who take decisions on the management of such patients. The population covered by these guidelines includes: patients with gastrooesophageal reflux disease or other risk factors for Barrett's (obesity, family history for Barrett's and oesophageal adenocarcinoma (OAC)); every patient with incident or prevalent Barrett's oesophagus regardless of their age, sex or comorbidities; patients with early OAC and patients with intestinal metaplasia (IM) at the gastro-oesophageal junction (GOJ) with no endoscopic evidence of Barrett's oesophagus. The previous British Society of Gastroenterology (BSG) development of the guidelines and to aid assessment of the quality of the guidelines. Three appraisers in the author list assessed the compliance of the guidelines to the AGREE II domains. As part of the AGREE II criteria, external review of this manuscript was also performed by two internationally renowne...

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Section: Practicalities Of Endosopic Surveillancementioning

confidence: 99%

British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus

Fitzgerald

Pietro

Ragunath

et al. 2013

Gut

1,183

1,297

View full text Add to dashboard Cite

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“…Evidence for the psychological morbidity associated with Barrett's CLO is limited,18 19 and perhaps only highlights the methodological limitations in applying quantifiable methods to studying patient experience and quality of life 20–22. The dearth of qualitative research into this condition has given little opportunity for the ‘voices’ of patients with Barrett's CLO to be heard.…”

Section: Introductionmentioning

confidence: 99%

Understanding Barrett's columnar lined oesophagus from the patients' perspective: qualitative analysis of semistructured interviews with patients

Griffiths

Davies

2011

Frontline Gastroenterol

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ObjectivesTo explore patients' views and perspectives on their experience of living with Barrett's columnar lined oesophagus (CLO) and being part of an endoscopic surveillance programme.DesignQualitative semistructured interviews.SettingDistrict General Hospital.Subjects22 men with diagnosis of Barrett's CLO between the ages of 50 and 70 years.ResultsAll subjects had received some information about Barrett's CLO and had a heightened awareness of the cancer risk. However, many had misinterpreted or poorly assimilated the information and overall health literacy levels were low. From their stories a ‘Model of Uncertainty’ in Barrett's surveillance was developed as a focus for healthcare professionals to ensure that the service users' perspective is considered in future service development.ConclusionPatients' assimilation of information should not be assumed by healthcare professionals but rather should be verified for individual patients. The model developed highlights the factors found to influence patients' knowledge and understanding of Barrett's CLO.

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“… Objective and subjective risk estimates are similar with each other. 58% of patients underestimated their 10‐year risk of developing cancer 60% of patients underestimated their objective risk estimations …”

Section: Resultsmentioning

confidence: 99%

Patients' intuitive judgments about surveillance endoscopy in Barrett's esophagus: a review and application to models of decision-making

et al. 2013

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SUMMARY Adherence to practice guidelines for endoscopic surveillance of Barrett’s esophagus is equivocal with evidence of underutilization and overutilization. While physicians report strong agreement with and adherence to recommended surveillance endoscopy (esophagogastroduodenoscopy [EGD]) guidelines, less is known about modifiable barriers and facilitators shaping patients’ adherence behaviors. The aim of this study is to conduct a structured literature review of studies exploring patients’ perspectives regarding surveillance EGD and to place these results within a conceptual framework. A structured literature review of PubMed, Cochrane, and Google Scholar databases with qualitative thematic analysis was performed. Six studies met eligibility criteria. Analysis of results identified five distinct themes. First, patients’ objective cancer risk estimates are consistent with subjective risk perceptions, but neither is associated with EGD surveillance. Second, patients have strong beliefs in the benefits of cancer screening and surveillance and trust in their doctors. Third, anxiety and depression symptoms are related to risk perceptions and outcome expectancies of surveillance. Fourth, endoscopic surveillance itself has affective and physical consequences. Finally, health services and system variables are related to risk perception and EGD surveillance. These themes coherently fit within an integrated model of intuitive decision-making and health behaviors. Studies meeting eligibility criteria were heterogeneous in terms of their study objectives and findings. Quantitative meta-analyses of study findings could not be performed. To improve adherence, endoscopic surveillance programs should consider how patients intuitively frame risks and benefits and patients’ emotional reactions to the endoscopy procedure, and focus on how physicians communicate recommendations.

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Endoscopic surveillance for Barrettʼs oesophagus: the patientsʼ perspective

Cited by 28 publications

References 23 publications

British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus

British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus

Understanding Barrett's columnar lined oesophagus from the patients' perspective: qualitative analysis of semistructured interviews with patients

Patients' intuitive judgments about surveillance endoscopy in Barrett's esophagus: a review and application to models of decision-making

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