Face-to-face vs telephone pre-colonoscopy consultation in colorectal cancer screening; a randomised trial

Abstract

Background: A pre-colonoscopy consultation in colorectal cancer (CRC) screening is necessary to assess a screenee's general health status and to explain benefits and risks of screening. The first option allows for personal attention, whereas a telephone consultation does not require travelling. We hypothesised that a telephone consultation would lead to higher response and participation in CRC screening compared with a face-to-face consultation.

Methods: A total of 6600 persons (50-75 years) were 1:1 randomised for primary colonoscopy screening with a pre-colonoscopy consultation either face-to-face or by telephone. In both arms, we counted the number of invitees who attended a pre-colonoscopy consultation (response) and the number of those who subsequently attended colonoscopy (participation), relative to the number invited for screening. A questionnaire regarding satisfaction with the consultation and expected burden of the colonoscopy (scored on five-point rating scales) was sent to invitees. Besides, a questionnaire to assess the perceived burden of colonoscopy was sent to participants, 14 days after the procedure.

Results: In all, 3302 invitees were allocated to the telephone group and 3298 to the face-to-face group, of which 794 (24%) attended a telephone consultation and 822 (25%) a face-to-face consultation (P=0.41). Subsequently, 674 (20%) participants in the telephone group and 752 (23%) in the face-to-face group attended colonoscopy (P=0.018). Invitees and responders in the telephone group expected the bowel preparation to be more painful than those in the face-to-face group while perceived burden scores for the full screening procedure were comparable. More subjects in the face-to-face group than in the telephone group were satisfied by the consultation in general: (99.8% vs 98.5%, P=0.014).

Conclusion: Using a telephone rather than a face-to-face consultation in a population-based CRC colonoscopy screening programme leads to similar response rates but significantly lower colonoscopy participation.

Figure 1

Study flow: response, participation and questionnaire completion. *Only a subsequent subset of 5924 invitees received the baseline questionnaire. The participants who belonged to this subset received the PBQ. The proportions of completed EBQ, SQ or PBQ are relative to this subset. **Non-participant who attended the consultation. ***Subjects with CRC-related symptoms. Abbreviations: EBQ=expected burden questionnaire; GP=general practitioner; PBQ=perceived burden questionnaire; SQ=satisfaction questionnaire.

Figure 2

Reluctance to undergo colonoscopy and expected embarrasement, pain and burden of bowel prep and colonoscopy. On top of the bars, mean score, s.d. (between parantheses), difference in mean scores and pooled s.d. (pSD) are displayed. Expected pain of the bowel preparation differed significantly between the groups (P=0.03), all other items were not statistically different.

Figure 3

Perceived embarrasement, pain and burden of the entire screening procedure (including bowel preparation colonoscopy itself, waiting for the test results, and abdominal complaints). On top of the bars, mean score, s.d. (between parantheses), difference in mean scores and pSD are displayed. None of the items were statistically different between the groups: pain (P=0.06), embarrassement (P=0.96) and burden (P=0.75).