Colorectal cancer may be the second-leading cause of cancer-related deaths in the United States and also one of the most preventable, but as many as one-third of people who should be screened aren't. Why? They're too scared of the procedure and too uncomfortable to talk to a doctor about it.
A recent study at New Hampshire's Dartmouth-Hitchcock Medical Center that used a web-based patient-engagement platform to connect with those in need of a colonoscopy might provide the key to overcoming those fears – and save a lot of lives and money in the process.
The randomized study, conducted at the Lebanon, N.H. hospital and involving the Geisel School of Medicine at Dartmouth and Emmi Solutions, pushed Emmi's interactive colonoscopy solution out to 52 first-time colonoscopy patients, who could watch the program at their own pace in their homes. Those patients were then surveyed, along with 51 patients who instead received the standard printed procedure packet.
According to researchers, those using the Emmi solution were 11 percent more informed about the procedure and had significantly lower anxiety scores on the day they underwent the procedure. Additionally, that group required 18 percent less sedation medication and helped reduce the length of the procedure by 14 percent.
“Patients have a lot of anxiety about colonoscopy, mostly due to uncertainty about the prep, the procedure and what might be found,” said Corey Siegel, MD, director of the Inflammatory Bowel Disease Center at Dartmouth-Hitchcock Medical Center. “If they come in more knowledgeable about the procedure, they know what to expect and are more comfortable and relaxed once they arrive at the hospital and during the procedure itself.”
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The impact of an mHealth-based patient engagement tool on this population could be profound. According to the Centers for Disease Control and Prevention, one out of every three Americans between the ages of 50 and 75 – 23 million people – have not been screened for colorectal cancer. According to the American Cancer Society, 102,480 new cases of colon cancer and 40,340 new cases of rectal cancer will be diagnosed in 2013, and will cause about 50,830 deaths this year.
The ACA recommends that men and women have a colonoscopy every 10 years, beginning at age 50. When colon cancer is caught early, 90 percent of patients remain alive five years later, but that five-year survival rate plunges to 12 percent if the cancer has already spread.
A colonoscopy can identify polyps in the colon that can be removed by doctors before they become cancerous. In addition, the procedure enables doctors to spot cancer at an earlier stage, improving one's chances of survival.
But in the general public's eye, a colonoscopy is about as pleasant as a root canal performed by an auto mechanic and without anesthetic.
"Frequently, a colonoscopy is scheduled for a patient without the patient meeting the gastroenterologist first. The typical scenario is a 'screening' colonoscopy, scheduled by the primary care doctor, and the patient doesn't meet their endoscopist until the day of the procedure," Siegel said. "So they don't really have a doctor that they know who they can call and ask questions. Therefore, any tools that can engage the patient and allow them to learn a little more about the procedure, and have questions answered, will likely increase their comfort and decrease anxiety."
Geri Lynn Baumblatt, editorial director for Chicago-based Emmi Solutions, said a patient engagement program vastly improves doctor-patient interaction, since the patient can access the web-based content at home.
"They're able to privately and discreetly type questions directly into the interactive program for their doctor to see prior to their procedure," she said. "Patients are prompted to feel safe to ask their doctors about any concerns they have – like hemorrhoids or other potentially embarrassing questions. They can also choose how much risk information they want to learn about – the basic overview of each risk, more in-depth information, or if they'd like to flag any of the risks for discussion … with their doctor."
Baumblatt said such mHealth tools could be used for any number of sensitive medical procedures.
"Absolutely. It already is being used for other procedures like colectomy, as well as gynecological procedures like hysterectomy, myomectomy, breast reductions and augmentations, and for men, procedures like prostatectomy and TURP," she said. "Multimedia programs like this are also being used to help patients make decisions for sensitive topics like low-risk prostate cancer, BPH or early-stage breast cancer treatment options, which involve a number of sensitive issues around sex, body image, potential impotence and bowel and bladder control, as well as for bariatric procedures and decisions around bariatric surgery, which often includes questions around weight, fertility, and for parents to help them understand delicate issues like hernias, orchiopexy and other procedures about which they have many sensitive questions about their child's anatomy and ability to function as they mature."
This isn't the first time that Emmi's colonoscopy solution has been involved in a study. In 2010, the University of Chicago Medicine conducted a study involving 1,740 patients age 50-65, and found that they were 40 percent less likely to cancel their colonoscopy appointment after viewing the Emmi video.
Siegel's one caveat for the platform is that physicians know what content is being sent to patients.
"Physicians will want to make sure that the information going out is consistent with their practice," he said. "There is a lot of variation around pre-procedure preparation and day-of-procedure events, so the information going out will have to be generic enough to be broadly applicable, but allow for enough detail that is helpful to the patient."
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