Planning management for complex colorectal polyps: a qualitative assessment of factors influencing decision-making among colonoscopists.

IF 3.3 Q2 GASTROENTEROLOGY & HEPATOLOGY
Jody Parker, Lenira Semedo, Lavanya Shenbagaraj, Jared Torkington, Sunil Dolwani
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引用次数: 0

Abstract

Objective: Endoscopic therapy is the recommended primary treatment for most complex colorectal polyps, but high colonic resection rates are reported. The aim of this qualitative study was to understand and compare between specialities, the clinical and non-clinical factors influencing decision making when planning management.

Design: Semi-structured interviews were performed among colonoscopists across the UK. Interviews were conducted virtually and transcribed verbatim. Complex polyps were defined as lesions requiring further management planning rather than those treatable at the time of endoscopy. A thematic analysis was performed. Findings were coded to identify themes and reported narratively.

Results: Twenty colonoscopists were interviewed. Four major themes were identified including gathering information regarding the patient and their polyp, aids to decision making, barriers in achieving optimal management and improving services. Participants advocated endoscopic management where possible. Factors such as younger age, suspicion of malignancy, right colon or difficult polyp location lead towards surgical intervention and were similar between surgical and medical specialties. Availability of expertise, timely endoscopy and challenges in referral pathways were reported barriers to optimal management. Experiences of team decision-making strategies were positive and advocated in improving complex polyp management. Recommendations based on these findings to improve complex polyp management are provided.

Conclusion: The increasing recognition of complex colorectal polyps requires consistency in decision making and access to a full range of treatment options. Colonoscopists advocated the availability of clinical expertise, timely treatment and education in avoiding surgical intervention and providing good patient outcomes. Team decision-making strategies for complex polyps may provide an opportunity to coordinate and improve these issues.

Abstract Image

复杂结肠息肉的计划管理:影响结肠镜医师决策因素的定性评估。
目的:内镜下治疗是大多数复杂结肠息肉的首选治疗方法,但据报道结肠切除率很高。本质性研究的目的是了解和比较专科、临床和非临床因素对计划管理决策的影响。设计:在英国结肠镜医师中进行半结构化访谈。采访以虚拟方式进行,并逐字记录。复杂息肉被定义为需要进一步管理计划的病变,而不是在内窥镜检查时可治疗的病变。进行了专题分析。研究结果被编码以确定主题,并以叙述的方式进行报告。结果:对20名结肠镜医师进行了访谈。确定了四个主要主题,包括收集有关患者及其息肉的信息,帮助决策,实现最佳管理的障碍和改善服务。与会者主张尽可能进行内窥镜治疗。年龄小、怀疑恶性肿瘤、右结肠或息肉定位困难等因素导致手术干预,在外科和内科专业之间相似。专家的可用性,及时的内窥镜检查和转诊途径的挑战被报道为最佳管理的障碍。团队决策策略在改善复杂息肉管理方面的经验是积极的和提倡的。基于这些发现提出了改善复杂息肉治疗的建议。结论:对复杂结直肠息肉的认识不断提高,需要决策的一致性和获得全面的治疗方案。结肠镜医师提倡临床专业知识的可用性,及时治疗和避免手术干预的教育,并提供良好的患者结果。复杂息肉的团队决策策略可能提供一个协调和改善这些问题的机会。
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来源期刊
BMJ Open Gastroenterology
BMJ Open Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.90
自引率
3.20%
发文量
68
审稿时长
2 weeks
期刊介绍: BMJ Open Gastroenterology is an online-only, peer-reviewed, open access gastroenterology journal, dedicated to publishing high-quality medical research from all disciplines and therapeutic areas of gastroenterology. It is the open access companion journal of Gut and is co-owned by the British Society of Gastroenterology. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Publishing procedures are built around continuous publication, publishing research online as soon as the article is ready.
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