Browsing by Author "Imperiale, Thomas"

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    47745 Low-risk Adenoma Surveillance Decision-making: Perspectives from Patients and Providers
    (Cambridge University Press, 2021) Maratt, Jennifer K.; Matthias, Marianne; Gowan, Tayler; Imperiale, Thomas; Medicine, School of Medicine
    ABSTRACT IMPACT: I hope that our work will improve surveillance endoscopy experiences, by engaging both patients and providers. OBJECTIVES/GOALS: A large proportion of colonoscopies are performed for post-polypectomy surveillance. Data show that there is overuse of surveillance for low-risk adenomas (LRAs), which can be attributed to patient and provider factors. The objective is to understand patient and provider perspectives for decision-making for LRA surveillance colonoscopy. METHODS/STUDY POPULATION: Semi-structured, one-on-one virtual interviews of patients and providers are currently being conducted at Richard L. Roudebush VA Medical Center and Eskenazi Health. Using a criterion sampling approach, we identified patients 50-75 years of age who had a screening colonoscopy with finding of LRAs, and providers in primary care and gastroenterology, at each site. We plan to recruit at least 8 patients and 8 providers from each site until thematic saturation. Domains that will be covered include: perceived involvement with surveillance decision-making; experiences with, and preferences for, communication about test results; and barriers and facilitators to undergoing colonoscopy. A 3-phase approach, comprising immersion, reduction, and interpretation, is being used to collect and analyze data. RESULTS/ANTICIPATED RESULTS: This study is currently in the recruitment phase and results will be forthcoming. DISCUSSION/SIGNIFICANCE OF FINDINGS: Understanding decision-making for LRA surveillance colonoscopy will inform future interventions to improve endoscopic resource use and efficiency while improving patient and provider experiences with endoscopic care coordination.
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    Early-Age Onset Colorectal Neoplasia in Average-Risk Individuals Undergoing Screening Colonoscopy: A Systematic Review and Meta-Analysis
    (Elsevier, 2021-10) Kolb, Jennifer M.; Hu, Junxiao; DeSanto, Kristen; Gao, Dexiang; Singh, Siddharth; Imperiale, Thomas; Lieberman, David A.; Boland, C. Richard; Patel, Swati G.; Medicine, School of Medicine
    Background/Aims Incidence and mortality associated with early age onset colorectal cancer (EAO-CRC) is increasing, prompting professional society recommendations to lower the screening age in average risk individuals. The yield of screening individuals <50 years old is not known. Methods A systematic review of 3 databases from inception through July 2020 was performed in all languages that reported colonoscopy findings in average risk individuals<50 years old. The primary outcomes were EAO colorectal neoplasia (EAO-CRN) and advanced colorectal neoplasia (EAO-aCRN) prevalence. Subgroup analyses were performed based on sex, geographic location, time period, and age including comparison to age 50-59. Generalized linear mixed model with random intercept logistic regression and fixed subgroup effects were performed Results Of 10,123 unique articles, 17 studies published between 2002-2020, including 51,811 average-risk individuals from four continents, were included. The pooled rate of EAO-CRN was 13.7% (95%CI: 0.112-0.168) and EAO-aCRN was 2.2% (95%CI: 0.016-0.031). Prevalence of CRC was .05% (0.00029-0.0008). Rates of EAO-CRN were higher in men compared to women (RR 1.71, 1.49–1.98), and highest in the United States (15.6%:12.2-19.7) compared to Europe (14.9%:6.9-29.3), East Asia (13.4%:10.3-17.2), and the Middle East (9.8%:7.8-12.2)(p=0.04) The rate of EAO-CRN in age 45-49 and 50-59 was 17.8% (14.5-21.6) and 24.8% (19.5-30.8), respectively (p=0.04). The rate of EAO-aCRN in age 45-49 was 3.6% (1.9-6.7) and 4.2% (3.2-5.7), respectively (p=0.69) Conclusions The rate of advanced colorecta neoplasia in individuals age 45-49 was similar to the rate observed in age 50-59, suggesting that expanding screening to this population could yield similar impact on colorectal cancer risk reduction.
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    Interventions to Promote Colorectal Cancer Screening in Primary Care: Results of a Randomized Trial
    (Office of the Vice Chancellor for Research, 2013-04-05) Rawl, Susan M.; Christy, Shannon M.; Perkins, Susan; Tong, Yan; Krier, Connie; Wang, Hsiao-Lan; Champion, Victoria L.; Myers, Laura Jones; Imperiale, Thomas; Willis, Deanna; Rhyant, Broderick; Springston, Jeffrey; Skinner, Celette Sugg
    Aims: The purpose of this randomized trial was to compare rates of self-reported colorectal cancer (CRC) screening and forward movement in stage of adoption at 6 months post-intervention. African American primary care patients (n=595) who were eligible for CRC screening were randomly assigned to receive a computer-delivered tailored CRC screening intervention (n=286) or a non-tailored screening brochure (n=309) prior to their scheduled visit with their primary care provider. Hypotheses were that differences between groups would be observed in proportions of patients who: 1) completed fecal occult blood tests (FOBT) or colonoscopy; and 2) had moved forward in stages of adoption for these tests. Methods: Participants completed baseline and 6-month telephone interviews; interventions were delivered prior to primary care provider visits. Differences between groups were examined using chi-square tests, predictors of screening were determined using logistic regression models. Results: In the computer-tailored group, the FOBT completion rate was 12.6% compared to 7.8% in the brochure group (p=0.05). The colonoscopy completion rate was 17.5% in the computer group vs. 15.2% in the brochure group (p=0.45). Forward stage movement for FOBT was observed in 28.4% of the computer groups vs. 20.8% in the brochure group (p=0.03). Forward stage movement for colonoscopy was 38.5% in the computer group and 36.8% (p=0.68) in each group, respectively. Conclusions: The computer-tailored intervention was more effective than the brochure at increasing FOBT completion and movement toward action. More research is needed to explain why the tailored intervention was not more effective at increasing colonoscopy completion and to identify moderators of intervention efficacy.
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    Retrospective, observational, cross-sectional study of detection of recurrent Barrett's esophagus and dysplasia in post-ablation patients with adjunctive use of wide-area transepithelial sample (WATS-3D)
    (Hellenic Society of Gastroenterology, 2022) Fatima, Hala; Wajid, Maryiam; Hamade, Nour; Han, Yan; Kessler, William; Dewitt, John; Rex, Douglas; Imperiale, Thomas; Medicine, School of Medicine
    Background: Barrett's esophagus (BE) and dysplasia are often missed by Seattle protocol biopsies (SPB). Wide-area transepithelial sampling with 3-dimensional computer-assisted analysis (WATS-3D) with SPB improves detection in treatment-naïve patients. We aimed to determine to what extent WATS-3D adds to SPB in the detection of non-dysplastic BE (NDBE) and dysplasia in patients undergoing post-endoscopic eradication therapy (EET). Methods: This retrospective, observational, cross-sectional study included patients who presented for post-EET surveillance with SPB and WATS-3D sampling from April 2019 to February 2020. BE patients with no previous EET were excluded. For the outcomes of NDBE and any dysplastic/neoplastic finding, we calculated both relative and absolute increases in yield by WATS-3D over SBP. Results: In 78 patients [mean age 68±10.4 years, 66 (84.6%) male], the prevalence of NDBE, any dysplastic/neoplastic finding, and any abnormality (NDBE or dysplasia/neoplasia) were 53.85%, 10.26%, and 55.13%. The absolute increase in yield of NDBE with WATS-3D over SPB was 26.9% (95% confidence interval [CI] 17.95-37.18%), with the number needed to treat (NNT) 3.71 (95%CI 2.69-5.57) and a relative increase in yield of 100% (95%CI 53.33-188.25%). For dysplasia/neoplasia, the absolute increase in yield was 6.4% (95%CI 1.28-12.82%), NNT 15.6 (95%CI 7.8-78.0), and relative increase of 167% (95%CI 33.33%-infinity). For any abnormal finding, the absolute increase in yield was 26.9% (95%CI 16.67-37.18%), NNT 3.71 (95%CI 2.69-6.00), and relative increase in yield 95% (95%CI 50-176.92%). Conclusions: WATS-3D with SPB improves the detection of residual/recurrent BE and dysplasia in post-ablation BE. However, randomized controlled trials are needed to validate these findings.