Clinical StudiesScreening for colorectal cancer with flexible sigmoidoscopy by nonphysician endoscopists
Section snippets
Material and methods
The study was conducted at the outpatient colorectal cancer screening program of Harvard Vanguard Medical Associates, a staff model health maintenance organization covering approximately 300,000 lives. All data were collected prospectively on a standardized form. Patients referred by their primary care provider for screening flexible sigmoidoscopy were contacted by phone and asked about demographic characteristics and risk factors for colorectal cancer, including personal or family history of
Results
Screening flexible sigmoidoscopy was performed on 3,701 patients between 1995 and 1997. Of these, 1,378 examinations were performed by 1 of 15 gastroenterologists, and 2,323 by the 3 nonphysicians (n = 726, 791, and 806 for each endoscopist). The baseline demographic characteristics of the patients are shown in Table 1. Compared with the patients examined by nonphysicians, those examined by physicians were younger, more likely to be male, and more likely to have a minor family history of
Discussion
In comparison with gastroenterologists, trained nonphysician endoscopists perform screening flexible sigmoidoscopy with similar accuracy and safety, but at lower cost. After adjusting for baseline differences in patient age and sex, nonphysicians had a slightly shorter depth of examination, but this did not result in a reduction in the rate of detection of neoplastic polyps, the primary purpose of screening. No major complications were observed in more than 3,000 examinations.
Schroy et al (12)
Acknowledgements
We would like to thank the gastroenterology staff of Harvard Vanguard Medical Associates for their efforts in data collection, and Jean Killiam, RN, Andrew Wallace, MD, Fran Cook, PhD, and Robert Fletcher, MD, for their assistance in preparation of the manuscript.
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