Screening CT Colonography: Multicenter Survey of Patient Experience, Preference, and Potential Impact on Adherence

Abstract

OBJECTIVE Prior research indicates CT colonography (CTC) would be a cost-effective colorectal cancer (CRC) screening test if widespread availability were to increase overall CRC screening adherence rates. The primary aims of this multicenter study were to evaluate patient experience and satisfaction with CTC screening and compare preference against screening colonoscopy. MATERIALS AND METHODS A 12-question survey instrument measuring pretest choice, experience, and satisfaction was given to a consecutive cohort of adults undergoing CTC screening in three disparate screening settings: university academic center, military medical center, and community practice. The study cohort was composed of individuals voluntarily participating in clinical CTC screening programs. RESULTS A total of 1417 patients responded to the survey. The top reasons for choosing CTC for screening included “noninvasiveness” (68.0%), “avoidance of sedation/anesthesia” (63.1%), “ability to drive after the test” (49.2%), “avoidance of optical colonoscopy risks” (46.9%), and “identifying abnormalities outside the colon” (43.3%). Only 7.2% of patients reported pain during the CTC examination and only 2.5% reported greater than moderate discomfort. Of 441 patients who had experienced both CTC and optical colonoscopy, 77.1% preferred CTC and 13.8% preferred optical colonoscopy. Of all patients, 29.6% indicated that they may not have undergone optical colonoscopy screening if CTC were not available. Of all patients, 92.9% labeled their overall experience with CTC as “excellent” or “good,” and 93.0% indicated they would choose CTC for their next screening. CONCLUSION Respondents reported a very high satisfaction level with CTC, and those who had experienced both modalities indicated a preference for CTC over optical colonoscopy. These results suggest that CTC has the potential to increase adherence to CRC screening guidelines if widely available.

Variation in Diagnostic Performance among Radiologists at Screening CT Colonography

“…Numerous studies have established CT colonography as a valid (2-8) and cost-effective (9,10) colorectal cancer screening test that is well-accepted by patients (11,12). The present study offers evidence that CT colonographic performance is also highly reproducible among radiologists with respect to clinically significant end points.…”

“…To A ccording to long-standing World Health Organization guidelines, several criteria exist for evaluation of the quality of screening procedures, including validity, reliability, cost, and acceptance (1). With respect to these characteristics, computed tomographic (CT) colonography has been well-studied and has been found to be a valid screening test for colorectal cancer and other advanced neoplasia (2)(3)(4)(5)(6)(7)(8), as well as a test demonstrating both cost-effectiveness (9,10) and a high degree of acceptance among patients (11,12). However, because of a lack of third-party coverage and other issues, widespread adoption of CT colonography as a screening modality has yet to occur in the United States.…”

CT Colonography with Computer-aided Detection: Recognizing the Causes of False-Positive Reader Results

“…However, patient compliance with optical colonoscopy is poor for several reasons, including discomfort with the procedure and bowel cleansing, as well as cost (6). CT colonography has rates of polyp detection comparable to those of optical colonoscopy, and its use may improve overall adherence to screening guidelines because it is minimally invasive, requires no sedation, has the potential for reduced cathartic examinations, and has faster patient throughput (4,(7)(8)(9)(10). Data support the cost-effectiveness of CT colonography (11).…”

Predictors of CT Colonography Utilization Among Asymptomatic Medicare Beneficiaries

“…[6][7][8] CTC is both safe and effective among the elderly, 9 and may even improve overall colorectal cancer screening rates by reaching patients who would not otherwise receive OC because of medical contraindications and patient preference. [10][11][12][13][14][15] In March 2009, the Centers for Medicare and Medicaid Services (CMS) denied coverage of CTC for asymptomatic patients (i.e. screening CTC), leading to substantial controversy about the potential value of CTC in the elderly population.…”