Clinician based decision tool to guide recommended interval between colonoscopies: development and evaluation pilot...

Area of Science:

• Gastroenterology
• Clinical Decision Support
• Health Services Research

Background:

• Determining optimal intervals for repeat colonoscopies is crucial for patient outcomes and cost-effectiveness.
• Current clinical practice in Winnipeg, Manitoba, shows variability in adherence to recommended colonoscopy screening intervals.

Purpose of the Study:

• To assess concordance between clinician-recommended and guideline-recommended colonoscopy screening intervals.
• To evaluate clinician perspectives on using an electronic decision-making tool for interval recommendations.
• To examine the initial implementation and use of a decision-making smartphone/web-based application.

Main Methods:

• Four focus groups (N=22) with endoscopists and primary care providers evaluated hypothetical colonoscopy scenarios.
• Clinician recommendations were compared against North American guidelines using Fisher's exact tests.
• A pilot study with 6 endoscopists assessed the use of a newly developed decision-making tool.

Main Results:

• 53% of clinicians agreed with guideline recommendations in 50% or fewer scenarios.
• Barriers to tool adoption included time, confidence in own judgment, and data accessibility (e.g., family history).
• Endoscopists in the pilot study deviated from guidelines 35% of the time and favored their own judgment over the tool's recommendation.

Conclusions:

• Endoscopists exhibit overconfidence and inconsistency in applying polyp surveillance guidelines.
• A decision support tool could enhance guideline knowledge and application.
• Practice change may necessitate combining decision tools with continuing education on evidence-based outcomes.