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When should ulcerative colitis patients undergo colectomy for dysplasia? Mismatch between patient preferences and physician recommendations

  1. Corey A. Siegel MD, MS1,2,*,
  2. Lisa M. Schwartz MD, MS2,
  3. Steven Woloshin MD, MS2,
  4. Elisabeth B. Cole BA, MS2,
  5. David T. Rubin MD3,
  6. Tegan Vay BA1,
  7. Judith Baars MSc1,
  8. Bruce E. Sands MD, MS4

Article first published online: 23 FEB 2010

DOI: 10.1002/ibd.21233

Issue

Inflammatory Bowel Diseases

Inflammatory Bowel Diseases

Volume 16, Issue 10, pages 1658–1662, October 2010

Additional Information

How to Cite

Siegel, C. A., Schwartz, L. M., Woloshin, S., Cole, E. B., Rubin, D. T., Vay, T., Baars, J. and Sands, B. E. (2010), When should ulcerative colitis patients undergo colectomy for dysplasia? Mismatch between patient preferences and physician recommendations. Inflamm Bowel Dis, 16: 1658–1662. doi: 10.1002/ibd.21233

Author Information

  1. 1

    Dartmouth-Hitchcock Inflammatory Bowel Disease Center, Lebanon, New Hampshire

  2. 2

    The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, New Hampshire

  3. 3

    University of Chicago Inflammatory Bowel Disease Center, Chicago, Illinois

  4. 4

    MGH Crohn's and Colitis Center and Gastrointestinal Unit, Boston, Massachusetts

*Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756

Publication History

  1. Issue published online: 23 FEB 2010
  2. Article first published online: 23 FEB 2010
  3. Manuscript Accepted: 23 DEC 2009
  4. Manuscript Received: 16 DEC 2009

Funded by

  • Foundation for Clinical Research in Inflammatory Bowel Disease
  • National Institute of Diabetes and Digestive and Kidney Diseases. Grant Number: K23DK078678

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Keywords:

  • ulcerative colitis;
  • colectomy;
  • colon cancer;
  • dysplasia;
  • patient preferences

Abstract

Background:

If dysplasia is found on biopsies during surveillance colonoscopy for ulcerative colitis (UC), many experts recommend colectomy given the substantial risk of synchronous colon cancer. The objective was to learn if UC patients' perceptions of their colon cancer risk and if their preferences for elective colectomy match with physicians' recommendations if dysplasia was found.

Methods:

A self-administered written survey included 199 patients with UC for at least 8 years (mean age 49 years, 52% female) who were recruited from Dartmouth-Hitchcock (n = 104) and the University of Chicago (n = 95). The main outcome was the proportion of patients who disagree with physicians' recommendations for colectomy because of dysplasia.

Results:

Almost all respondents recognized that UC raised their chance of getting colon cancer. In all, 74% thought it was “unlikely” or “very unlikely” to get colon cancer within the next 10 years and they quantified this risk to be 23%; 60% of patients would refuse a physician's recommendation for elective colectomy if dysplasia was detected, despite being told that they had a 20% risk of having cancer now. On average, these patients would only agree to colectomy if their risk of colon cancer “right now” were at least 73%.

Conclusions:

UC patients recognize their increased risk of colon cancer and undergo frequent surveillance to reduce their risk. Nonetheless, few seem prepared to follow standard recommendations for elective colectomy if dysplasia is found. This may reflect the belief that surveillance alone is sufficient to reduce their colon cancer risk or genuine disagreement about when it is worth undergoing colectomy. Inflamm Bowel Dis 2010

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