Background
In 2006, the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society published updated guidelines for colonoscopy follow-up after polypectomy. A growing body of data suggests that gastroenterologists often recommend repeat colonoscopy for colonic polyp surveillance more frequently than guidelines recommend. Overuse of colonoscopy for polyp surveillance poses a significant economic burden, may contribute to decreased colonoscopy capacity for initial screening, and increases the risk of complications.
Incomplete knowledge of guideline recommendations among gastroenterologists probably explains some of the guideline nonadherence. In a survey of gastroenterologists' knowledge of 2003 colonoscopy surveillance guidelines, 76% of those who correctly answered knowledge-related questions reported that their practice was to repeat colonoscopy sooner than guidelines suggested. This implies that other factors, such as legal risk, reimbursement, and disagreement with the evidence base supporting the guidelines, may also contribute to guideline nonadherence. Better characterizing these potential determinants is the first step toward ultimately improving guideline adherence.
We conducted a survey to assess factors that may contribute to physicians' recommendations for colonoscopy intervals after polypectomy. We also sought to determine whether the patterns of colonoscopy overuse observed in community-based studies were also reported in a salaried, managed-care setting, the Veterans Affairs (VA) health system, where reimbursement and legal concerns may not play as prominent a role in determining behavior.