From: Reuters
Published January 23, 2008 11:31 AM

Peer coaching helps bring people in for colon test

By Anne Harding

NEW YORK (Reuters Health) - Coaching from a peer who has been there and done that can help people go through with a first-time colonoscopy, new research shows.

"We know that even when people tell the physician that they're willing to have a colonoscopy that at least a third ... don't keep the appointment for a variety of reasons," Dr. Barbara J. Turner of the University of Pennsylvania School of Medicine in Philadelphia, the study's lead researcher, told Reuters Health.

Regular colonoscopies are recommended beginning at age 50 to screen for colorectal cancer, Turner pointed out, but worries about preparation, pain, or modesty prevent many people from getting this potentially lifesaving exam. "It's like bicycle riding -- once you go and get it you're OK but you really need to get past that initial time," Turner said.

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She and her colleagues had previously examined how primary care doctors informed their patients about colonoscopy, and found "they did a pretty miserable job of it" -- for example, using unpleasant language or being vague about what the procedure entailed, she said.

To see if peer counselors might do a better job, Turner and her team looked at 275 people at four primary care practices who had been scheduled for their first colonoscopy but were considered quite likely not to show up for the appointment, because they missed more than 25 percent of their regular doctor visits.

Sixty-six of the participants were assigned to receive a brochure by mail, 70 got a call from a peer coach within two weeks of the scheduled procedure, 49 were determined not to need support, 41 refused support, and 49 couldn't be contacted, the investigators report in the Journal of General Internal Medicine.

Patients who got peer counseling were twice as likely as those who received brochures to keep their colonoscopy appointment, Turner and her team found. The coached patients were just as likely to get the screening test as the patients who were judged not to need additional support.

Attendance by the patients who refused support and those who couldn't be contacted was lower than the brochure group, but similar from a statistical standpoint.

"There are people who are really shutting down on getting this lifesaving procedure and they don't want anyone even talking to them about it," Turner noted.

The failure of many people to get screened for colon cancer is a "great tragedy," Turner said, especially because regular colonoscopies can identify precancerous polyps, which can then be removed even before cancer develops. "It is not like breast cancer -- you don't have to wait until you get cancer to do something about it," she explained. "It is a cancer that should be largely preventable if you could get people to do it."

Women may be so focused on breast cancer that they neglect to get screened for colon cancer, which is the third leading cancer killer for women, Turner added. "It's not on their radar, but it needs to be."

SOURCE: Journal of General Internal Medicine, January 2008.

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