Subject Recall Following Sigmoidoscopy: Are We Really Educating Our Patients?

Introduction: Colorectal cancer (CRC) is the second leading cause of cancer-related death in men and women combined. Patients of low socioeconomic status (SES) are among the lowest screened, increasing mortality rates. There continue to be large racial/ethnic disparities in CRC screening (CRCS), owing in part to low health literacy and further complicated by language barriers. A model for free one-time sigmoidoscopy for patients needing CRCS has been reported, the goal of which is to prevent cancer-related death and raise awareness of CRC in populations with poor access to health resources. The aim of this study was to evaluate patient recall post-procedure to determine if common communication methods are effective in a low SES, low health literacy population. Methods: Patients ages 50-75 at average risk for CRC were recruited from 2 free screening health fairs in one county. All sigmoidoscopies were performed during a free CRCS fair. No sedation was used. Post-procedure, a standardized script developed for common procedure findings was used to communicate results, which were explained in the patients' preferred language. Patients then completed a rapid assessment survey to evaluate recall. If the patients were unable to recall from memory, standardized visual prompts were used to assist with answering questions. Results: A total of 38 patients were screened; 66% women, 57% employed, and 95% reporting an income of less than $2000 monthly. 92% were non-English speaking (71% Spanish, 21% Creole). 85% with a single diagnosis after sigmoidoscopy were able to recall the results of their procedure; of the 29% of patients with multiple findings, none could recall multiple diagnoses. Only 50% of patients could accurately recall recommendations given by the provider, and 18% of patients reported they were not given recommendations. 82% of patients were able to recall the time interval to their next recommended CRCS. Conclusion: The majority of patients were able to partially recall their results, with an inverse relationship between recall and number of endoscopic diagnoses. Most patients had short-term recall of the suggested interval for subsequent screening. This study emphasizes the need for improvement in communicating results of CRCS to patients of low SES, especially for those in whom English is not a primary language.