Dis Colon Rectum. 2021 Dec 20. doi: 10.1097/DCR.0000000000002213. Online ahead of print.
BACKGROUND: Surgeons commonly repeat preoperative endoscopy prior to planned colorectal resections. The reasons for this are not entirely clear and repeat endoscopy may lead to delays in curative resection, increased costs, and patient discomfort.
OBJECTIVE: Our aim was to determine practice patterns, localization techniques, and processes of communication undertaken by endoscopy specialists in a high-volume regional health authority.
DESIGN: This was a qualitative study involving standardized, semi-structured, in-depth interviews that were conducted in person. Data were analyzed using a thematic analysis approach. Ten general surgeons and 10 gastroenterologists were included, using a convenience sampling technique.
SETTINGS: The study was conducted at Canadian tertiary and community facilities.
MAIN OUTCOME MEASURES: Interview questions were developed to understand the perspectives and practice patterns of endoscopists when approaching patients diagnosed with colorectal lesions requiring surgical resection. The decision-making process to perform a repeat preoperative endoscopy was assessed.
RESULTS: Three key themes emerged: 1) patterns of communication, 2) feedback, and 3) trust. Thematic analysis revealed that poor communication and ambiguous documentation increased the likelihood of performing repeat preoperative endoscopy. Inconsistencies in tattooing practices and lesion location were important factors. Negative past experiences and factors related to interprofessional trust emerged as key contributors to repeat preoperative endoscopy.
LIMITATIONS: The transferability of findings to health care systems outside of Canada may be limited and requires further study.
CONCLUSIONS: Suboptimal endoscopic reporting contributes to gaps in communication amongst endoscopists. In addition, lack of consistent feedback and mutual trust may increase the likelihood of performing repeat preoperative lower endoscopy. Inconsistent tattooing practices pose significant concerns for accurate intraoperative lesion localization. Establishing collaborative work environments through joint educational initiatives may enhance communication and mitigate unnecessary repeat procedures. These results support the need for standardized guidelines and endoscopic reporting in the management of colorectal lesions. See Video Abstract at http://links.lww.com/DCR/B879 .
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