University of Colorado Anschutz Medical Center, 12631 E 17th Avenue, Room 7614, Campus Box 158, Aurora, CO, 80045, USA.
Rocky Mountain Regional Veterans Affairs Hospital, Aurora, CO, USA.
Dig Dis Sci. 2020 Sep;65(9):2542-2550. doi: 10.1007/s10620-020-06167-9. Epub 2020 Mar 6.
Advanced colorectal polyps (adenoma or sessile serrated polyp ≥ 1 cm, adenoma with villous features, adenoma with high-grade dysplasia, or any sessile serrated polyps with dysplasia) are associated with an increased risk of future advanced colorectal neoplasia and confer an increased risk of advanced neoplasia to first-degree family members. Professional societies therefore recommend more intensive surveillance of these polyps and earlier screening for first-degree relatives. The aim of this study was to assess knowledge of personal and familial risk and recommendations among patients with advanced colorectal polyps and identify predictors of knowledge.
An online survey was designed to assess the domains of knowledge and risk perception regarding personal and familial colorectal cancer risk and screening recommendations. After expert review and pilot testing, the 37-item survey was electronically sent to all patients diagnosed with an advanced colon or rectal polyp under the age of 60. Patient report of polyp findings was compared to documented findings in the medical record. Univariable and multivariable regressions were performed to evaluate predictors of knowledge.
One hundred thirty-seven out of 344 (39.8%) eligible patients responded to the survey. 28.5% of participants reported that the polyp they had removed was precancerous. 54.8% of participants reported that they have a higher risk of CRC, and 65.2% reported that they should be undergoing colonoscopy surveillance in 3 years or less. 40.1% reported that their first-degree family members are at increased CRC risk, and 38.0% reported that first-degree family members should get earlier screening. Participants reported their endoscopists as their top source of information about risk and recommendations, though only 7.3% of endoscopists made recommendations for family members. Female gender and higher income were predictors of accurate knowledge, as endoscopist was the main source of knowledge.
Patients with advanced colorectal polyps have poor knowledge of personal and familial CRC risk and recommendations. Endoscopists who remove advanced polyps are in an ideal position to educate their patients about their personal risk and the risk and recommendations for first-degree family members.
高级结直肠息肉（腺瘤或无蒂锯齿状息肉≥1cm、腺瘤伴绒毛特征、腺瘤伴高级别异型增生、或任何伴异型增生的无蒂锯齿状息肉）与未来发生高级结直肠肿瘤的风险增加相关，并使一级亲属发生高级别肿瘤的风险增加。因此，专业协会建议对这些息肉进行更密集的监测，并对一级亲属进行更早的筛查。本研究旨在评估高级结直肠息肉患者对个人和家族风险及推荐意见的了解情况，并确定其知识的预测因素。
设计了一项在线调查，以评估关于个人和家族结直肠癌风险和筛查建议的知识和风险感知领域。经过专家审查和试点测试后，将 37 项调查项目以电子方式发送给所有年龄在 60 岁以下被诊断为高级结肠或直肠息肉的患者。将患者报告的息肉发现与病历中的记录发现进行比较。进行单变量和多变量回归分析，以评估知识的预测因素。
在 344 名符合条件的患者中，有 137 名（39.8%）患者对调查做出了回应。28.5%的参与者报告说，他们切除的息肉是癌前病变。54.8%的参与者报告说他们有更高的 CRC 风险，65.2%的人报告说他们应该在 3 年内或更短时间内进行结肠镜检查监测。40.1%的人报告说他们的一级亲属有更高的 CRC 风险，38.0%的人报告说一级亲属应该更早接受筛查。参与者报告说，他们的内镜医生是他们了解风险和建议的主要信息来源，尽管只有 7.3%的内镜医生对家庭成员提出了建议。女性性别和更高的收入是准确知识的预测因素，内镜医生是知识的主要来源。
患有高级结直肠息肉的患者对个人和家族 CRC 风险及推荐意见的了解不足。切除高级息肉的内镜医生处于教育患者了解其个人风险以及一级亲属的风险和建议的理想位置。
