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Regarding “Issues of informed consent for non-specialists conducting colorectal cancer screenings”

  • Sareena Ali ORCID logo , Robert Mowery ORCID logo and Ryan T. Hoff ORCID logo EMAIL logo
Published/Copyright: June 11, 2024
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 124 Issue 11

We applaud the efforts of Bohler and Garden in their article entitled “Issues of informed consent for non-specialists conducting colorectal cancer screenings” [1]. They present evidence of higher complications and lower quality metrics in non-gastroenterologist providers (NGPs) who perform colonoscopies and propose this should be acknowledged during informed consent. Indeed, the quality of colonoscopy may be variable in rural areas [2], and NGPs perform most colonoscopies for Medicare patients in rural areas [3]. However, there are some additional points that require clarification and further discussion.

First, the authors report that family medicine residents in the US complete on average 42.6 colonoscopies during their residency training. However, this number only represents family medicine residents who received any such training; in 2003, only 18 % of US family medicine programs provided colonoscopy training [4].

The authors suggest NGPs referencing reported rates of complications may be misleading when much of that data is from physicians “… who received more training than the gastroenterologists [1].” We believe the authors intended to state this was misleading because it was based on providers who received more training than the non-gastroenterologists.

Though not mentioned, similar to adenoma detection rate (ADR), detection of sessile serrated lesions (SSLs) is also inversely correlated with risk of post-colonoscopy colorectal cancer (CRC) [5, 6]. Some physicians may have low detection rates of SSLs despite a high ADR [7] and detection rates vary widely by physician [8, 9]. However, with significant variability in pathologic identification of such polyps, SSL detection rate is not yet a defining quality metric for colonoscopy [7, 10]. Still, higher detection of SSLs has been seen with gastroenterologists compared with non-gastroenterologists [11]. Strategies to optimize ADR and SSL detection rate include high quality bowel preparation, meticulous examination with withdrawal time >6 min, and the use of high-definition white light [12].

The authors suggest that stool-based testing may increase CRC surveillance rates; we believe the authors intended that such tests may improve screening rates. Unlike screening, surveillance occurs in patients at higher risk due to a personal history of CRC, polyps, etc. Currently, stool-based testing has no role in CRC surveillance in the US, though it has been studied [13], [14], [15].

We appreciate the efforts of Bohler and Garden for presenting evidence regarding differences between colonoscopies performed by NGPs vs. gastroenterologists, and how this should be addressed during informed consent. Ultimately, the decision to pursue a screening colonoscopy with an NGP remains between the patient and their physician, but having a clearer, more detailed informed consent is essential in this process.

Corresponding author: Ryan T. Hoff, DO, PeaceHealth Southwest Medical Center, Vancouver, WA 98664, USA; and Elson S. Floyd College of Medicine, Washington State University, 505 NE 87th Avenue, Building B, Suite 301, Vancouver, WA 98664-1989, USA, E-mail:

  1. Research ethics: Not applicable.

  2. Informed consent: Not applicable.

  3. Author contributions: RTF and SA provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; all authors drafted the article or revised it critically for important intellectual content; all authors gave final approval of the version of the article to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  4. Competing interests: None declared.

  5. Research funding: None declared.

  6. Data availability: Not applicable.

References

1. Bohler, F, Garden, A. Issues of informed consent for non-specialists conducting colorectal cancer screenings. J Osteopath Med 2023;124:39–42. https://doi.org/10.1515/jom-2023-0149.Search in Google Scholar PubMed

2. Brajcich, BC, Yang, AD, Keswani, RN, Kreutzer, L, Molt, PL, Rossi, MB, et al.. The quality of screening colonoscopy in rural and underserved areas. Surg Endosc 2022;36:4845–53. https://doi.org/10.1007/s00464-021-08833-z.Search in Google Scholar PubMed

3. Carmichael, H, Samuels, JM, Velopulos, CG, Jones, EL. Geographic distribution of colonoscopy providers in the United States: an analysis of Medicare claims data. Surg Endosc 2022;36:7673–8. https://doi.org/10.1007/s00464-022-09083-3.Search in Google Scholar PubMed

4. Wilkins, T, Jester, D, Kenrick, J, Dahl, J. The current state of colonoscopy training in family medicine residency programs. Fam Med 2004;36:407–11.Search in Google Scholar

5. Anderson, JC, Rex, DK, Mackenzie, TA, Hisey, W, Robinson, CM, Butterly, LF. Higher serrated polyp detection rates are associated with lower risk of postcolonoscopy colorectal cancer: data from the New Hampshire colonoscopy registry. Am J Gastroenterol 2023;118:1927. https://doi.org/10.14309/ajg.0000000000002403.Search in Google Scholar PubMed PubMed Central

6. Van Toledo, DEFWM, IJspeert, JEG, Bossuyt, PMM, Bleijenberg, AGC, van Leerdam, ME, van der Vlugt, M, et al.. Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer: a population-based study [published correction appears in Lancet Gastroenterol Hepatol. 2023;8(7):e6]. Lancet Gastroenterol Hepatol 2022;7:747–54. https://doi.org/10.1016/S2468-1253(22)00090-5.Search in Google Scholar PubMed

7. Rex, DK. Key quality indicators in colonoscopy. Gastroenterol Rep 2023;11:goad009. https://doi.org/10.1093/gastro/goad009.Search in Google Scholar PubMed PubMed Central

8. Hetzel, JT, Huang, CS, Coukos, JA, Omstead, K, Cerda, SR, Yang, S, et al.. Variation in the detection of serrated polyps in an average risk colorectal cancer screening cohort. Am J Gastroenterol 2010;105:2656–64. https://doi.org/10.1038/ajg.2010.315.Search in Google Scholar PubMed

9. Kahi, CJ, Hewett, DG, Norton, DL, Eckert, GJ, Rex, DK. Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy. Clin Gastroenterol Hepatol 2011;9:42–6. https://doi.org/10.1016/j.cgh.2010.09.013.Search in Google Scholar PubMed

10. Shaukat, A, Kahi, CJ, Burke, CA, Rabeneck, L, Sauer, BG, Rex, DK. ACG clinical guidelines: colorectal cancer screening 2021. Am J Gastroenterol 2021;116:458–79. https://doi.org/10.14309/ajg.0000000000001122.Search in Google Scholar PubMed

11. Telford, J, Gondara, L, Pi, S, Gentile, L, Enns, R. Higher adenoma detection, sessile serrated lesion detection and proximal sessile serrated lesion detection are associated with physician specialty and performance on Direct Observation of Procedural Skills. BMJ Open Gastroenterol 2021;8:e000677. https://doi.org/10.1136/bmjgast-2021-000677.Search in Google Scholar PubMed PubMed Central

12. Ma, MX, Bourke, MJ. Sessile serrated adenomas: how to detect, characterize and resect. Gut Liver 2017;11:747–60. https://doi.org/10.5009/gnl16523.Search in Google Scholar PubMed PubMed Central

13. Pin-Vieito, N, Puga, M, Fernández-de-Castro, D, Cubiella, J. Faecal immunochemical test outside colorectal cancer screening? World J Gastroenterol 2021;27:6415–29. https://doi.org/10.3748/wjg.v27.i38.6415.Search in Google Scholar PubMed PubMed Central

14. Lincoln, A, Benton, S, Piggott, C, North, BV, Rigney, J, Young, C, et al.. Exploring the utility and acceptability of faecal immunochemical testing (FIT) as a novel intervention for the improvement of colorectal cancer (CRC) surveillance in individuals with lynch syndrome (FIT for lynch study): a single-arm, prospective, multi-centre, non-randomised study. BMC Cancer 2022;22:1144. https://doi.org/10.1186/s12885-022-10217-y.Search in Google Scholar PubMed PubMed Central

15. Winter, JM, Cornthwaite, KJ, Young, GP, Wilson, C, Chen, G, Woodman, R, et al.. FIT for purpose: study protocol for a randomized controlled trial to personalize surveillance colonoscopy for individuals at elevated risk of colorectal cancer. Int J Colorectal Dis 2023;38:201. https://doi.org/10.1007/s00384-023-04493-8.Search in Google Scholar PubMed PubMed Central

Received: 2024-02-11
Accepted: 2024-04-25
Published Online: 2024-06-11

© 2024 the author(s), published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

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https://doi.org/10.1515/jom-2024-0026
Creative Commons
BY 4.0

Articles in the same Issue

  1. Frontmatter
  2. Medical Education
  3. Original Article
  4. Concerns of osteopathic medical students during the COVID-19 pandemic
  5. Musculoskeletal Medicine and Pain
  6. Original Article
  7. Pelvic joint stiffness and fear of falling in patients over 75 years of age: a prospective cohort study of 100 patients
  8. Neuromusculoskeletal Medicine (OMT)
  9. Review Article
  10. A systematic review of manual therapy modalities and anxiety
  11. Pediatrics
  12. Original Article
  13. Association of prenatal substance exposure and the development of the amygdala, hippocampus, and parahippocampus
  14. Public Health and Primary Care
  15. Original Article
  16. Feasibility of a cinematic-virtual reality training program about opioid use disorder for osteopathic medical students: a single-arm pre–post study
  17. Letters to the Editor
  18. Regarding “Issues of informed consent for non-specialists conducting colorectal cancer screenings”
  19. Response to: Regarding “Issues of informed consent for non-specialists conducting colorectal cancer screenings”
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