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Patients' Willingness To Share Limited Endoscopic Resources: Results Of A Large Regional Survey
Piper MS, Kurlander J, Zikmund-Fisher BJ, Maratt JK, Waljee AK, Saini SD. Patients' Willingness To Share Limited Endoscopic Resources: Results Of A Large Regional Survey. Poster session presented at: Digestive Disease Week Annual Conference; 2016 May 22; San Diego, CA.
Background: In some health systems, patients face long wait times for elective endoscopic procedures. For such procedures, patients are typically scheduled using a "first come, first serve" approach. But this approach may lead to delayed procedures for higher risk patients. One alternative is to use state-of-the-art prediction models to prioritize scheduling according to risk. Yet, we know little about the acceptability of such an approach to patients.
Patients and Methods: We developed a multiple-choice, scenario-based survey to elicit attitudes towards repeat screening colonoscopy. Potential survey participants were identified electronically using the endoscopic database at the VA Ann Arbor Healthcare System. We identified participants who met the following criteria: (1) age 50; (2) prior complete, normal average-risk screening colonoscopy with adequate bowel preparation. Individuals were excluded if they had a personal or family history of colon cancer or adenomas, or a personal history of inflammatory bowel disease (IBD). We examined a subgroup of questions about attitudes towards risk-based prioritization of colonoscopy scheduling. Specifically, we asked respondents whether they would be willing to wait up to 6 months to get a repeat screening colonoscopy so that higher-risk patients could be screened first. Multivariable ordinal logistic regression was used to identify patients factors associated with greater willingness to wait.
Results: 1,054 of 1,500 possible respondents completed the survey (72%). Respondents were predominantly white (86%) and male (94%). The median age was 60-69 years. Many patients (46%) were eager to undergo screening colonoscopy, reporting that they would want a screening colonoscopy even if they had serious, life-limiting health problems and a physician recommendation to stop screening. Despite this, patients reported a strong willingness to delay their own colonoscopy so that another, higher-risk patient could undergo colonoscopy sooner. Specifically, 94% of respondents stated they would definitely (65%) or probably (29%) be willing to delay their own colonoscopy. In multivariable analysis, factors that predicted greater willingness to wait were: (1) better self-reported health (OR: 3.65; 95% CI: 1.29-10.3); (2) greater trust in physician (OR: 1.40; 95% CI: 1.24-1.58). Factors that predicted less willingness to wait were: (1) lower health literacy (OR: 0.29; 95% CI: 0.13-0.64); (2) greater perceived threat of CRC (OR: 0.88; 95% CI: 0.83-0.93); (3) non-white race (OR: 0.39; 95% CI: 0.24-0.62).
Conclusion: Despite having a strong personal interest in repeat screening, previously screened patients were almost universally willing to delay their own screening colonoscopy for higher risk patients. Appealing to altruism could be effective in situations where scarce resources must be utilized wisely.