Background
Surveillance guideline recommendations
Adherence to surveillance guideline recommendations
Efforts to increase adherence to guidelines
Aims
Methods
Setting and approvals
Participants
Procedure
Experimental groups
Control
Intervention
Measures
Primary outcome: adherence to surveillance guidelines for colonoscopy
Statistical methods
Effect of guideline change
Guidelines recommendations | ||
Examples | Old guidelines: Colonoscopy that visualises the entire colon should be performed at the time of diagnosisa. If this is not possible, colonoscopy should be performed within 3–6 months of surgery. Colonoscopy should be performed 3–5 years after surgery. | New guidelines: Colonoscopy should be performed one year after the resection, unless a complete post-operative colonoscopy has been performed sooner. |
Classification of adherence | ||
Colonoscopy at diagnosis; no colonoscopy reported at 12 month follow up | Adherent | Non-adherent |
Colonoscopy at diagnosis; followed by colonoscopy 12 months later | Non-adherent | Adherent |
Colonoscopy at diagnosis, and then another colonoscopy within 6 months of surgery | Adherent | Adherent |
Colonoscopy 6 months post surgery; no subsequent colonoscopy reported at 12 month follow up | Adherent | Adherent |
Colonoscopy 6 months post surgery; subsequent colonoscopy reported at 12 month follow up | Non-adherent | Non-adherent |
Results
Sample characteristics
Variable | Control | Intervention |
---|---|---|
N = 299 |
N = 305 | |
n (%) |
n (%) | |
Age (n = 653) | Mean = 66 (SD = 11) | Mean = 68 (SD = 12) |
under 50 | 16 (5%) | 18 (6%) |
50–59 | 60 (20%) | 55 (18%) |
60–69 | 98 (33%) | 83 (27%) |
70–79 | 85 (28%) | 81 (27%) |
over 80 | 40 (13%) | 68 (22%) |
Male (n = 653) | 171 (57%) | 154 (50%) |
Married/defacto (n = 653) | 230 (77%) | 205 (67%) |
Born in Australia (n = 591) | 205 (77%) | 223 (80%) |
Urban dwelling (n = 652) | 202 (68%) | 194 (64%) |
Education (n = 651) | ||
University or vocational training | 99 (33%) | 200 (33%) |
Secondary school completed | 44 (14%) | 87 (14%) |
Secondary school not completed | 161 (53%) | 315 (52%) |
Employed (n = 653) | 106 (32%) | 98 (34%) |
Private health insurance (n = 653) | 197 (66%) | 201 (66%) |
Previous cancer diagnosis (n = 652) | 33 (11%) | 54 (18%) |
Left-sided tumour (n = 649) | 177 (59%) | 162 (54%) |
Disease stage (n = 652) | ||
TNM Stage I | 95 (32%) | 98 (33%) |
TNM Stage II | 100 (34%) | 115 (38%) |
TNM Stage III | 99 (34%) | 88 (29%) |
Returned a follow up survey (n = 653) | 246 (82%) | 257 (84%) |
Died in follow-up period | 11 (4%) | 7 (2%) |
Days between diagnosis and Intervention (n = 653) | Median = 219 (IQR:171-281) | Median = 226 (IQR:189-281) |
Primary outcome: adherence to surveillance colonoscopy guidelines
Intervention (N = 270)
n (%) | Control (N = 259)
n (%) | Total (N = 529)
n (%) | |
---|---|---|---|
Adherent at follow up | 80(32%) | 67(27%) | 147(29%) |
Non-adherent at follow up | 174(69%) | 179(73%) | 353(71%) |
Under screened | 10(3.9%) | 17(6.9%) | 27(5.4%) |
Over screened | 164(65%) | 162(66%) | 326(65%) |
Characteristics associated with adherence
Variable | Adherent to surveillance guidelines | Odds ratio |
P value* |
---|---|---|---|
(95% CI) | |||
Experimental group | |||
Control | 55 (26%) | REF | |
Intervention | 66 (29%) | 1.01 (0.64–1.6) | 0.954 |
Age | |||
under 50 | 3 (14%) | 0.44 (0.11–1.83) | |
50–59 | 14 (17%) | 0.56 (0.24–1.34) | |
60–69 | 31 (22%) | 0.77 (0.42–1.4) | |
70–79 | 39 (31%) | REF | |
over 80 | 34 (47%) | 2 (1.05–3.98) | 0.049 |
Sex | |||
Male | 68 (29%) | REF | |
Female | 53 (26%) | 0.91 (0.56–1.47) | 0.697 |
Highest level of education | |||
University or vocational training | 34 (22%) | REF | |
Secondary school completed | 23 (34%) | 1.6 (0.8–3.12) | |
Secondary school not completed | 64 (29%) | 1.03 (0.6–1.77) | 0.367 |
Relationship status | |||
Single | 36 (33%) | REF | |
Married/defacto | 85 (26%) | 1.01 (0.58–1.76) | 0.97 |
Employment status | |||
Not employed | 95 (33%) | REF | |
Employed | 26 (17%) | 0.58 (0.3–1.12) | 0.107 |
Australian born | |||
No | 24 (26%) | REF | |
Yes | 97 (28%) | 1.2 (0.68–2.14) | 0.519 |
Location or residence | |||
Rural | 52 (34%) | REF | |
Urban | 69 (24%) | 0.65 (0.4–1.05) | 0.081 |
Private health insurance | |||
No | 44 (34%) | REF | |
Yes | 77 (25%) | 0.81 (0.49–1.33) | 0.406 |
Disease stage | |||
TNM Stage I | 45 (31%) | REF | |
TNM Stage II | 44 (27%) | 0.67 (0.39–1.16) | |
TNM Stage III | 32 (24%) | 0.76 (0.43–1.36) | 0.349 |
Cancer site | |||
Right sided | 45 (24%) | REF | |
left-sided | 76 (30%) | 1.8 (1.13–3.02) | 0.014 |
Saw specialist for follow up care | |||
No | 14 (61%) | REF | |
Yes | 107 (26%) | 0.35 (0.14–0.91) | 0.031 |