P3860 - Decreasing Patient Fear of Colonoscopy After an Abnormal Fecal Immunochemical Test: Results from a Pilot Video Decision Aid

Talor Hopkins, MPA¹, Ari Bell-Brown, MPH¹, Pedro Martinez-Pinto, ², Vida Henderson, PhD, PharmD², Linda K.. Ko, PhD², Rachel B.. Issaka, MD, MAS^1
1Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA; ²Fred Hutchinson Cancer Center, Seattle, WA

Introduction: Abnormal fecal immunochemical test (FIT) results must be followed by a colonoscopy to effectively reduce colorectal cancer (CRC)-mortality. In most healthcare settings, follow-up colonoscopy rarely exceeds 50%. We and others have identified fear of colonoscopy as an important barrier to address, especially in safety-net systems, where FIT is commonly used. Therefore, we developed and piloted a video decision aid aimed to address fear of colonoscopy among patients with abnormal FIT results at Harborview Medical Center (HMC), a large, urban, safety-net healthcare system.

Methods: In partnership with advisors, we finalized a script, obtained live colonoscopy footage from a consented patient, and produced a video to facilitate patient decision-making regarding colonoscopy completion. HMC patients with an abnormal FIT result in the past 3 years who had not completed a colonoscopy were randomized 1:1 to the video or usual care per their primary care provider. All participants completed a baseline survey for demographic information and to assess fear (e.g., pain from procedure, prep, CRC), knowledge about CRC, self-efficacy and intent to complete a colonoscopy. Participants randomized to the video (intervention) completed a post-intervention survey for similar measures and an acceptability questionnaire.

Results: Between May 2023 and May 2024, 60 eligible patients were randomized to the intervention or usual care (Table 1). Post-intervention, participants reported a 13.3% overall decrease in fear of colonoscopy across all measures, including a 20.7% decrease in fear of a colonoscopy being painful, a 17.3% decrease in fear of the bowel prep, and a 50.0% decrease in uncertain or negative intent to complete a colonoscopy. Compared to usual care, fewer participants randomized to the intervention reported that CRC must cause pain before diagnosis (35.7% vs. 15.6%, p=0.04). Overall, 78.3% of participants found the video to be helpful and 90.6% would recommend the video to other patients with abnormal FIT results.

Discussion: Our video decision aid decreased fear of colonoscopy, increased knowledge about CRC (e.g., CRC can occur without pain) and intent to complete a colonoscopy in a population with abnormal FIT results. On demand, point-of-care videos offer a potentially scalable and cost-effective strategy to improve follow-up colonoscopy after non-invasive CRC screening tests and can be incorporated into multilevel interventions to address this issue.


Disclosures:


Talor Hopkins, MPA¹, Ari Bell-Brown, MPH¹, Pedro Martinez-Pinto, ², Vida Henderson, PhD, PharmD², Linda K.. Ko, PhD², Rachel B.. Issaka, MD, MAS¹. P3860 - Decreasing Patient Fear of Colonoscopy After an Abnormal Fecal Immunochemical Test: Results from a Pilot Video Decision Aid, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.