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Browsing by Author "Barrett, Patrick R."
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Item Patient Understanding of Benefits, Risks, and Alternatives to Screening Colonoscopy(2013-02) Schwartz, Peter H.; Edenberg, Elizabeth; Barrett, Patrick R.; Perkins, Susan M.; Meslin, Eric M.; Imperiale, Thomas F.BACKGROUND: While several tests and strategies are recommended for colorectal cancer (CRC) screening, studies suggest that primary care providers often recommend colonoscopy without providing information about its risks or alternatives. These observations raise concerns about the quality of informed consent for screening colonoscopy. METHODS: We conducted a telephone survey (August 2008 to September 2009) of a convenience sample of 98 patients scheduled for a screening colonoscopy to assess their understanding of the procedure’s benefits, risks, and alternatives and their sources of information. RESULTS: Fully 90.8% of subjects described the purpose of screening colonoscopy in at least general terms. Just 48.0% described at least one risk of the procedure. Only 24.5% named at least one approved alternative test. Just 3.1% described the minimal required elements for informed consent: the benefit of colonoscopy, both of the major risks, and at least one approved alternative test. Compared to subjects with higher levels of education or income, fewer subjects with lower levels of education or income could name at least one risk of colonoscopy or one approved alternative test to colonoscopy. For benefits, risks, and alternatives, a smaller percentage of subjects responding reported obtaining information from their doctors than from other sources. CONCLUSIONS: Patients scheduled for screening colonoscopy have limited knowledge of its risks and alternatives; subjects with lower education levels and lower income have even less understanding. For patients who do not receive additional information until they have begun the preparation for the test, the quality of informed consent may be low.Item Report from the PredictER Expert Panel Meeting, November 2, 2007(2008-10-27T16:44:59Z) Barrett, Patrick R.; Meslin, Eric M.; Schwartz, Peter H.; Girod, Jennifer; Odell, Jere D.; Quaid, Kimberly; Wolf, James G.On November 2, 2007, the Indiana University Center for Bioethics convened an expert panel on predictive health research (PHR) as part of the Center’s Program in Predictive Health Ethics Research (http://www.bioethics.iu.edu/predicter.asp) which is supported by a grant from the Richard M. Fairbanks Foundation. The goal of this meeting was to identify the major obstacles and opportunities for engaging the community in PHR. PredictER intends to use the results of this meeting as a first step toward more fully engaging the Indianapolis community in discussions about PHR.Item Should We Measure Adenoma Detection Rate for Gastroenterology Fellows in Training?(Elmer Press, 2018-08) El-Halabi, Mustapha M.; Barrett, Patrick R.; Mateo, Melissa Martinez; Fayad, Nabil F.; Medicine, School of MedicineBackground: Adenoma detection rate (ADR) is a proven quality metric for colonoscopy. The value of ADR for the evaluation of gastroenterology fellows is not well established. The aim of this study is to calculate and evaluate the utility of ADR as a measure of competency for gastroenterology fellows. Methods: Colonoscopies for the purposes of screening and surveillance, on which gastroenterology fellows participated at the Richard L. Roudebush VAMC (one of the primary training sites at Indiana University), during a 9-month period, were included. ADR, cecal intubation rate, and indirect withdrawal time were measured. These metrics were compared between the levels of training. Results: A total of 591 screening and surveillance colonoscopies were performed by 14 fellows. This included six, four and four fellows, in the first, second and third year of clinical training, respectively. Fellows were on rotation at the VAMC for a mean of 1.9 months (range 1 to 3 months) during the study period. The average ADR was 68.8% (95% CI 65.37 - 72.24). The average withdrawal time was 27.59 min (95% CI 23.45 - 31.73). The average cecal intubation rate was 99% (95% CI 98-100%). There was no significant difference between ADRs, cecal intubation rates, and withdrawal times at different levels of training; however, a trend toward swifter withdrawal times with advancing training was noted. Conclusions: ADR appears not to be a useful measure of competency for gastroenterology fellows. Consideration should be given to alternative metrics that could avoid bias and confounders.