Patient Time Requirements for Screening Colonoscopy
Patient Time Requirements for Screening Colonoscopy
Objective: To measure the amount of time patients spend in the screening colonoscopy process.
Methods: We recruited patients from a university endoscopy center scheduled to undergo screening colonoscopy. Participants completed a time diary for the screening colonoscopy process to account for time spent in preparation, travel, waiting, colonoscopy, and recovery.
Results: A total of 110 subjects completed the study. The sample was 57% female, 85% white, and 90% insured (40% Medicare, 4% Medicaid). Patients spent a median of about 21 h in the screening colonoscopy process for preparation, travel, waiting, colonoscopy, and onsite recovery. They invested a median of 16.5 h in preparation, 1.1 h traveling, 1.4 h waiting, 12 minutes for sedation, and 20 minutes for colonoscopy. Median time spent at the endoscopy center was 2.8 h. Median onsite recovery time was 47 minutes. Median time from the completion of the colonoscopy procedure until returning to routine activities was 17.7 h. Median time from the completion of the colonoscopy procedure until feeling completely back to normal was 19.9 h. Patient time requirements were sensitive to having a history of depression, type of person accompanying the patient, income, and employment status.
Conclusions: Screening colonoscopy requires a substantial commitment of time. A small portion of that time is spent at the endoscopy center or having the colonoscopy. The majority of that time is spent in preparation and recovery. Time is a potential barrier to screening, but advances in preparation and sedation practices could reduce the time required for patients.
Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States. Fortunately, there are several effective screening tests available that can decrease mortality from CRC. However, screening rates remain low in the United States despite the availability of effective screening tests and recommendations for CRC screening. With colonoscopy becoming the most popular screening tool in recent years, it is important to identify and reduce patient and system barriers to its use. One important barrier from the patient perspective is time. Colonoscopy requires more patient time investment than other CRC screening modalities, and is likely the most time-intensive of all screening tests. The time required includes not only the time for the procedure itself but also preparation time, travel time, waiting time, and recovery time.
Understanding and measuring patient time for screening colonoscopy is important for several reasons. First, excessive time requirements may be a barrier to undergoing recommended screening. Several studies have shown that travel time, waiting time, or other time requirements were barriers to health care. Second, measuring time requirements can inform quality improvement efforts focused on improving practice efficiency. Increased efficiency will allow for greater colonoscopy screening capacity, an important issue for policy makers because of the potential shortfall in meeting the demand of the population for screening. Third, time requirements may play an important role in medical decision-making. For patients to make informed decisions, they should be provided with information about risks, benefits, and costs (including time). Fourth, time requirements are needed to accurately assess the true costs and cost-effectiveness of different options for screening in economic analyses. The consensus Panel on Cost-Effectiveness in Health and Medicine, convened by the U.S. Public Health Service, recommends the incorporation of patient time costs in economic analyses. Failure to include these costs is particularly important in analyses of screening, because most people who engage in screening will not have the disorder in question, and thus will expend time and effort without tangible gain in health.
While some studies have attempted to measure the amount of patient time related to a variety of health care activities, none have done so for the screening colonoscopy process. Further, none have used prospective patient time diaries, which may be the only way to obtain reliable data on time allocation. In this study, we used patient time diaries to measure time invested in the screening colonoscopy process.
Abstract and Introduction
Abstract
Objective: To measure the amount of time patients spend in the screening colonoscopy process.
Methods: We recruited patients from a university endoscopy center scheduled to undergo screening colonoscopy. Participants completed a time diary for the screening colonoscopy process to account for time spent in preparation, travel, waiting, colonoscopy, and recovery.
Results: A total of 110 subjects completed the study. The sample was 57% female, 85% white, and 90% insured (40% Medicare, 4% Medicaid). Patients spent a median of about 21 h in the screening colonoscopy process for preparation, travel, waiting, colonoscopy, and onsite recovery. They invested a median of 16.5 h in preparation, 1.1 h traveling, 1.4 h waiting, 12 minutes for sedation, and 20 minutes for colonoscopy. Median time spent at the endoscopy center was 2.8 h. Median onsite recovery time was 47 minutes. Median time from the completion of the colonoscopy procedure until returning to routine activities was 17.7 h. Median time from the completion of the colonoscopy procedure until feeling completely back to normal was 19.9 h. Patient time requirements were sensitive to having a history of depression, type of person accompanying the patient, income, and employment status.
Conclusions: Screening colonoscopy requires a substantial commitment of time. A small portion of that time is spent at the endoscopy center or having the colonoscopy. The majority of that time is spent in preparation and recovery. Time is a potential barrier to screening, but advances in preparation and sedation practices could reduce the time required for patients.
Introduction
Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States. Fortunately, there are several effective screening tests available that can decrease mortality from CRC. However, screening rates remain low in the United States despite the availability of effective screening tests and recommendations for CRC screening. With colonoscopy becoming the most popular screening tool in recent years, it is important to identify and reduce patient and system barriers to its use. One important barrier from the patient perspective is time. Colonoscopy requires more patient time investment than other CRC screening modalities, and is likely the most time-intensive of all screening tests. The time required includes not only the time for the procedure itself but also preparation time, travel time, waiting time, and recovery time.
Understanding and measuring patient time for screening colonoscopy is important for several reasons. First, excessive time requirements may be a barrier to undergoing recommended screening. Several studies have shown that travel time, waiting time, or other time requirements were barriers to health care. Second, measuring time requirements can inform quality improvement efforts focused on improving practice efficiency. Increased efficiency will allow for greater colonoscopy screening capacity, an important issue for policy makers because of the potential shortfall in meeting the demand of the population for screening. Third, time requirements may play an important role in medical decision-making. For patients to make informed decisions, they should be provided with information about risks, benefits, and costs (including time). Fourth, time requirements are needed to accurately assess the true costs and cost-effectiveness of different options for screening in economic analyses. The consensus Panel on Cost-Effectiveness in Health and Medicine, convened by the U.S. Public Health Service, recommends the incorporation of patient time costs in economic analyses. Failure to include these costs is particularly important in analyses of screening, because most people who engage in screening will not have the disorder in question, and thus will expend time and effort without tangible gain in health.
While some studies have attempted to measure the amount of patient time related to a variety of health care activities, none have done so for the screening colonoscopy process. Further, none have used prospective patient time diaries, which may be the only way to obtain reliable data on time allocation. In this study, we used patient time diaries to measure time invested in the screening colonoscopy process.
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