Post-polypectomy Guideline Adherence: Importance of Belief in Guidelines, Not Guideline Knowledge or Fear of Missed Cancer

Background: Adherence to post-polypectomy surveillance guideline recommendations is suboptimal. Surveillance is frequently over- and under-recommend, resulting in strained colonoscopy capacity, potential risks without expected benefits, and missed opportunities for colorectal cancer risk reduction. Aims: To identify factors associated with adherence to post-polypectomy surveillance guidelines. Methods: We conducted a three-phase study with a retrospective review of usual care post-polypectomy surveillance recommendations through medical chart abstraction (Phase I), prospective online physician survey (Phase II), and analysis of survey-based and other physician-based predictors of usual care surveillance recommendations (Phase III). Subjects included patients who underwent usual care colonoscopy 2011–2012 (Phases I and III) and gastroenterology (GI) attendings and fellows (Phases II and III). We identified rates of recommendations consistent with guideline adherence, surveillance overuse, and surveillance underuse based on usual care medical chart documentation and physician survey, as well as predictors of physician adherence to guidelines. Results: We reviewed 640 patient charts for 28 survey respondents. Rates of usual practice recommendations consistent with guideline adherence, surveillance overutilization, and underutilization were 84, 13, and 3 %, respectively. At survey, 82 % of physicians were concerned about missed cancer. Eleven percentage believed that guidelines were not aggressive enough. GI trainees were 2.5 times more likely to issue guideline-adherent recommendations [OR 2.5, 95 % CI (1.5–4.2)]. Disagreement with guideline aggressiveness was independently associated with 40 % lower likelihood of adherence [OR 0.6, 95 % CI (0.4–0.8)]. Conclusions: Belief in the appropriate aggressiveness of guidelines and trainee position, but not fear of missed cancer or guideline knowledge, was associated with adherence to post-polypectomy surveillance guidelines.