Sewitch Maida J, Stein Dara, Joseph Lawrence, Bitton Alain, Hilsden Robert J, Rabeneck Linda, Paszat Lawrence, Tinmouth Jill, Cooper Mary Anne
Department of Medicine, McGill University, Montreal, Quebec.
Can J Gastroenterol. 2010 Nov;24(11):656-60. doi: 10.1155/2010/328178.
determining whether a colonoscopy is performed for screening or nonscreening purposes can facilitate clinical practice and research. However, there is no simple method to determine the colonoscopy indication using patient medical files or health administrative databases.
to determine patient-endoscopist agreement on the colonoscopy indication.
a cross-sectional study was conducted among staff endoscopists and their patients at seven university-affiliated hospitals in Montreal, Quebec. The study participants were 50 to 75 years of age, they were able to understand English or French, and were about to undergo colonoscopy. Self- (endoscopist) and interviewer-administered (patient) questionnaires ascertained information that permitted classification of the colonoscopy indication. Patient colonoscopy indication was defined as the following: perceived screening (routine screening, family history, age); perceived nonscreening (follow-up); medical history that implied nonscreening; and a combination of the three preceding indications. Agreement between patient and endoscopist indications was measured using concordance and Kappa statistic.
in total, 702 patients and 38 endoscopists participated. The three most common reasons for undergoing colonoscopy were routine screening⁄regular check-up (33.8%), follow-up to a previous problem (30.2%) and other problem (24.6%). Concordance (range 0.79 to 0.85) and Kappa (range 0.58 to 0.70) were highest for perceived nonscreening colonoscopy. Recent large bowel symptoms accounted for 120 occurrences of disagreement in which the patient perceived a nonscreening colonoscopy while the endoscopist perceived a screening colonoscopy.
patient self-report may be an acceptable means for rapidly assessing whether a colonoscopy is performed for screening or nonscreening purposes. Delivery of patient-centred care may help patients and endoscopists reach a shared understanding of the reason for colonoscopy.
确定结肠镜检查是用于筛查还是非筛查目的有助于临床实践和研究。然而，使用患者病历或健康管理数据库来确定结肠镜检查指征并没有简单的方法。
确定患者与内镜医师在结肠镜检查指征方面的一致性。
在魁北克省蒙特利尔市的7家大学附属医院对在职内镜医师及其患者进行了一项横断面研究。研究参与者年龄在50至75岁之间，能够理解英语或法语，且即将接受结肠镜检查。通过自我（内镜医师）和访谈者管理（患者）问卷确定了可用于对结肠镜检查指征进行分类的信息。患者结肠镜检查指征定义如下：感知到的筛查（常规筛查、家族史、年龄）；感知到的非筛查（随访）；暗示非筛查的病史；以及前三种指征的组合。使用一致性和卡帕统计量来衡量患者和内镜医师指征之间的一致性。
共有702名患者和38名内镜医师参与。进行结肠镜检查的三个最常见原因是常规筛查/定期检查（33.8%）、对先前问题的随访（30.2%）和其他问题（24.6%）。对于感知到的非筛查结肠镜检查，一致性（范围为0.79至0.85）和卡帕值（范围为0.58至0.70）最高。近期大肠症状导致120例不一致情况，即患者认为是非筛查结肠镜检查而内镜医师认为是筛查结肠镜检查。
患者自我报告可能是快速评估结肠镜检查是用于筛查还是非筛查目的的可接受方法。提供以患者为中心的护理可能有助于患者和内镜医师就结肠镜检查的原因达成共同理解。
