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Randomized Controlled Trial
. 2016 Apr;65(4):616-24.
doi: 10.1136/gutjnl-2014-307503. Epub 2015 Feb 10.

Leadership training to improve adenoma detection rate in screening colonoscopy: a randomised trial

Michal F Kaminski  1 , John Anderson  2 , Roland Valori  3 , Ewa Kraszewska  1 , Maciej Rupinski  1 , Jacek Pachlewski  1 , Ewa Wronska  1 , Michael Bretthauer  4 , Siwan Thomas-Gibson  5 , Ernst J Kuipers  6 , Jaroslaw Regula  1
Affiliations
Randomized Controlled Trial

Leadership training to improve adenoma detection rate in screening colonoscopy: a randomised trial

Michal F Kaminski et al. Gut. 2016 Apr.

Abstract

Objective: Suboptimal adenoma detection rate (ADR) at colonoscopy is associated with increased risk of interval colorectal cancer. It is uncertain how ADR might be improved. We compared the effect of leadership training versus feedback only on colonoscopy quality in a countrywide randomised trial.

Design: 40 colonoscopy screening centres with suboptimal performance in the Polish screening programme (centre leader ADR ≤ 25% during preintervention phase January to December 2011) were randomised to either a Train-Colonoscopy-Leaders (TCLs) programme (assessment, hands-on training, post-training feedback) or feedback only (individual quality measures). Colonoscopies performed June to December 2012 (early postintervention) and January to December 2013 (late postintervention) were used to calculate changes in quality measures. Primary outcome was change in leaders' ADR. Mixed effect models using ORs and 95% CIs were computed.

Results: The study included 24,582 colonoscopies performed by 38 leaders and 56,617 colonoscopies performed by 138 endoscopists at the participating centres. The absolute difference between the TCL and feedback groups in mean ADR improvement of leaders was 7.1% and 4.2% in early and late postintervention phases, respectively. The TCL group had larger improvement in ADR in early (OR 1.61; 95% CI 1.29 to 2.01; p<0.001) and late (OR 1.35; 95% CI 1.10 to 1.66; p=0.004) postintervention phases. In the late postintervention phase, the absolute difference between the TCL and feedback groups in mean ADR improvement of entire centres was 3.9% (OR 1.25; 95% CI 1.04 to 1.50; p=0.017).

Conclusions: Teaching centre leaders in colonoscopy training improved important quality measures in screening colonoscopy.

Trial registration number: NCT01667198.

Keywords: ADENOMA; CLINICAL TRIALS; COLONOSCOPY; COLORECTAL ADENOMAS; COLORECTAL CANCER SCREENING.

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Figures

Figure 1
Figure 1
Study flowchart. *One screening centre leader did not participate in the nurse assessment.
Figure 2
Figure 2
Mean (with 95% CIs) adenoma detection rate (ADR), proximal adenoma detection rate (pADR) and non-polypoid lesion detection rate (flatPDR) in the preintervention phase (2011), early postintervention phase (2012) and late postintervention phase (2013) by study group. Panel A shows data for screening centre leaders. Panel B shows data for entire screening centres. TCL, Train-Colonoscopy-Leader group; Feedback, feedback group.
See this image and copyright information in PMC

Comment in

References

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