Preference and Experience of Colonic Examination for Participants Presenting to Hospitals with a Positive Fecal Immunochemical Test Result

Abstract

Takashi Kato,1 Koichi Nagata,2,3 Junta Yamamichi,4 Soichi Tanaka,5 Tetsuro Honda,6 Norihito Shimizu,7 Kenichi Utano,8 Michiaki Hirayama,9 Hiroshi Matsumoto,10 Shoichi Horita1 1Department of Internal Medicine, Hokkaido Gastroenterological Hospital, Sapporo, Japan; 2Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan; 3Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan; 4Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan; 5Department of Coloproctology, Matsuaikai Matsuda Hospital, Hamamatsu, Japan; 6Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki, Japan; 7Department of Radiology, Medical Corporation Matsuoka Clinic, Nara, Japan; 8Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Fukushima, Japan; 9Department of Gastroenterology, Tonan Hospital, Sapporo, Japan; 10Department of Gastroenterology, Kawasaki Medical University School of Medicine, Kurashiki, JapanCorrespondence: Takashi KatoDepartment of Internal Medicine, Hokkaido Gastroenterological Hospital, Sapporo, Hokkaido 065-0041, JapanTel [phone]Fax [phone]Email [email protected]: Patients who test positive on the fecal immunochemical test (FIT) for colorectal cancer (CRC) are referred for colonoscopy for further diagnostic evaluation. Colonoscopy is not a perfect method and may be a challenge for some FIT-positive patients. Computed tomographic colonography (CTC) is an alternative method that is less invasive and allows examination of the whole colon. The study objective was to evaluate the preference of FIT-positive patients for either colonoscopy or CTC for CRC examination.Patients and Methods: Individuals older than 40 years with a positive FIT test at eight Japanese hospitals between December 2012 and July 2015 were invited to participate. Participants were given detailed information regarding colonoscopy and CTC before deciding on either examination. They completed questionnaires before the procedure regarding their preference and after the procedure regarding their experience.Results: The pre- and post-questionnaires of 846 and 834 participants, respectively, were analyzed. Participants preferred colonoscopy over CTC (colonoscopy, 72%; CTC, 28%). The possibility of obtaining biopsy samples and removing colorectal polyps during the procedure was the main reason for colonoscopy selection. Patients selected CTC to reduce discomfort but reported that CTC bowel preparation was more burdensome than colonoscopy bowel preparation. The overall experience of the examination did not differ between the groups.Conclusion: Colonoscopy is the standard examination for FIT-positive patients. However, when given a choice, almost one-third of participants chose CTC because they thought it would be a more “comfortable” examination. Clinicians should therefore be aware of patients’ potential preference for noninvasive colorectal examinations.Keywords: computed tomographic colonography, colonoscopy, patient preference, fecal immunochemical test

Keywords

• computed tomographic colonography
• colonoscopy
• patient preference
• fecal immunochemical test