Protocol for a national, multicentre study of post-endoscopy colorectal and upper gastrointestinal cancers: The POET study.

AIM: The primary aim of the study is to define the post-colonoscopy colorectal cancer (PCCRC) three-year rate and the post-endoscopy upper gastrointestinal cancer (PEUGIC) three-year rate across public hospitals in Aotearoa New Zealand. METHOD: This retrospective cohort study will be conducted via the trainee-led STRATA Collaborative network. All public hospitals in Aotearoa New Zealand will be eligible to participate. Data will be collected on all adult patients who are diagnosed with colorectal adenocarcinoma within 6 to 48 months of a colonoscopy and all adult patients diagnosed with gastroesophageal cancer within 6 to 48 months of an upper gastrointestinal endoscopy. The study period will be from 2010 to 2022. The primary outcome is the PCCRC 3-year rate and the PEUGIC 3-year rate. Secondary aims are to define and characterize survival after PCCRC or PEUGIC, the cause of PCCRC as based on the World Endoscopy Organization System of Analysis definitions, trends over time, and centre level variation. CONCLUSION: This protocol describes the methodology for a nationwide retrospective cohort study on PCCRC and PEUGIC in Aotearoa New Zealand. These data will lay the foundation for future studies and quality improvement initiatives.

Colonoscopy quality indicators in patients with and without prior colonic resection: A single-centre prospective comparative study.

AIM: Effective colonoscopy relies on meeting rigorous quality control thresholds. Some earlier studies evaluating colonoscopy key performance indicators (KPIs) have excluded patients who have previously undergone colonic resection (i.e., they have a nonintact colon); such patients also deserve high-quality colonoscopy. This study aimed to compare colonoscopy KPIs between patients with nonintact and intact colons. METHOD: Consecutive colonoscopies performed at Whanganui Hospital (New Zealand) between September 2016 and March 2020 were included. The primary outcome was the caecal or ileal intubation rate (CIIR). Secondary outcomes were the adenoma detection rate (ADR), polyp detection rate (PDR), colonoscope withdrawal time (CWT) and caecal or ileal intubation time (CIIT). RESULTS: In total, 3017 colonoscopies were performed: 322 in nonintact colons and 2695 in intact colons. CIIR was significantly higher in nonintact than in intact colons (98.4% vs. 95.0%; P = 0.0086). When all colonoscopies were included, the CIIR was 95.4%; this value decreased to 95.0% when nonintact colonoscopies were excluded. However, the ADR (39.9% vs. 38.8%; P = 0.77) and PDR (58.4% vs. 59.1%; P = 0.86) were similar for both nonintact and intact colons. CWT (P < 0.0001) and CIIT (P < 0.0001) were significantly shorter in participants with nonintact colons. CONCLUSION: The CIIR exceeded recommended targets and was 3.4% higher in patients with nonintact than intact colons. Patients with nonintact colons comprise a small proportion of the overall colonoscopy cohort and it is unlikely that this small difference is relevant for most endoscopists or endoscopy units. The ADR and PDR were similar among patients with nonintact and intact colons, despite nonintact colonoscopies being significantly quicker. Patients with nonintact colons deserve high-quality colonoscopy and therefore their KPIs should be included in colonoscopy performance reports.

Equity of colonoscopy provision and quality in Maori and New Zealand Europeans: a comparative retrospective study.

BACKGROUND: High-quality colonoscopy is essential for investigating suspected colorectal cancer and relies on endoscopists meeting key performance indicator (KPI) targets. The rising demand for colonoscopy raises concerns that Maori populations could be under-served. This study aimed to compare rates of colonoscopy provision and colonoscopy KPIs between Maori and New Zealand (NZ) European patients. METHODS: This retrospective comparative study was conducted at Whanganui Hospital (NZ). Consecutive colonoscopies performed between September 2016 and March 2020 were included. Primary outcome was the rate of colonoscopy provision for the population. Secondary outcomes were the colonoscopy completion rate (CCR), colonoscope withdrawal time (CWT), polyp detection rate (PDR) and adenoma detection rate (ADR). Subgroup analysis of ADR in index symptomatic colonoscopies was also performed. RESULTS: A total of 2962 colonoscopies were analysed (385 Maori; 2577 NZ European). Rates of colonoscopy provision in participants aged ≥40 were significantly lower among Maori (6.1% versus 9.1%; P < 0.0001). The CCR (P = 1.00), CWT (P = 0.28) and PDR (P = 0.24) were similar. Whilst the ADR in the overall cohort was significantly lower in Maori (32.7% versus 40.0%; P = 0.028), this was not observed when stratified by 10-year age cohorts. The ADR was similar on subgroup analysis of index symptomatic colonoscopies (P = 0.42). CONCLUSIONS: This study found inequities in access to colonoscopy services for Maori compared to NZ European patients. Among those that did receive colonoscopy, there were no differences in colonoscopy quality after age stratification. Improving equity will require the addition of colonoscopy provision rates to other mandatory KPIs and reporting these by ethnicity in all endoscopy units.

Individualised follow-up booklets improve recall and satisfaction for cancer patients.

AIMS: The New Zealand Provisional Standards of Service Provision for Cancer recommend providing patients with written information about their diagnosis, treatment and follow up. This project aimed to develop and evaluate a resource that could be used to provide essential information to patients who were nearing completion of the surgical treatment of their cancer. METHODS: The study compared patients with melanoma, colorectal and breast cancers who received standard discussion of their diagnosis, treatment and follow-up plan with cancer patients who received a discussion supported by an individualised follow-up booklet. Patients were interviewed using an over-the-phone questionnaire to assess their free recall and prompted recall of follow-up items, their perception of the level of information received and satisfaction with the communication of their follow-up plan. RESULTS: The group who received a booklet as part of discussion of their follow-up plan scored significantly higher on measures of free recall, prompted recall, satisfaction with the level of information provided and overall satisfaction than those who had a standard clinic discussion but did not receive a booklet. Free recall of two relevant items improved from 61% of patients to 91%. Prompted recall of at least one item improved from 77% of patients to 100%. The proportion of patients feeling they did not receive enough information fell from 25% to 5%. The proportion of patients scoring their satisfaction at >8/10 increased from 68% to 87%. All of these measures reached significance. CONCLUSION: Individualised cancer follow-up booklets are a simple, low-cost and low-risk initiative that used in a New Zealand setting, was associated with improved patient recall and satisfaction with the follow-up information they received. This supports the benefit of providing participants with personalised written information, as recommended in the New Zealand Provisional Standards of Service Provision for Cancer.

Judging a book by its cover: descriptive survey of patients' preferences for doctors' appearance and mode of address.

OBJECTIVE: To document patients' preferred dress styles of their doctors and modes of address. DESIGN: Descriptive survey. SETTING: Inpatients and outpatients at a tertiary level hospital, New Zealand. PARTICIPANTS: 202 inpatients and 249 outpatients, mean age 55.9 (SD 19.3) years. MAIN OUTCOME MEASURES: Ranking of patients' opinions of photographs showing doctors wearing different dress styles. A five point Likert scale was used to measure patient comfort with particular items of appearance. RESULTS: Patients preferred doctors to wear semiformal attire, but the addition of a smiling face was even better. The next most preferred styles were semiformal without a smile, followed by white coat, formal suit, jeans, and casual dress. Patients were more comfortable with conservative items of clothing, such as long sleeves, covered shoes, and dress trousers or skirts than with less conservative items such as facial piercing, short tops, and earrings on men. Many less conservative items such as jeans were still acceptable to most patients. Most patients preferred to be called by their first name, to be introduced to a doctor by full name and title, and to see the doctor's name badge worn at the breast pocket. Older patients had more conservative preferences. CONCLUSIONS: Patients prefer doctors to wear semiformal dress and are most comfortable with conservative items; many less conservative items were, however, acceptable. A smile made a big difference.

Affective disorders in the first-degree relatives of bipolar probands: results from the South Island Bipolar Study.

The current study was performed to document observed rates of affective disorders in the first degree relatives of probands with bipolar I or II disorder; to determine whether bipolar II probands have an excess of bipolar II relatives; and to determine whether bipolar probands with a history of one or more suicide attempts have more relatives who have also made suicide attempts. Bipolar probands with positive family histories of affective disorder were recruited from a variety of sources for a study on the molecular genetics of bipolar disorder. Probands and relatives were interviewed with the Diagnostic Interview for Genetic Studies (DIGS) and blood was obtained for DNA extraction and genetic analyses. Among 423 first-degree adult relatives of 153 bipolar probands, 7% (29) had bipolar I disorder, 7% had bipolar II disorder, and 7% had bipolar not otherwise specified (NOS) disorder, making 21% of relatives with any bipolar disorder. A further 42% of relatives had a depressive disorder and only 38% had no affective disorder. A suicide attempt by a proband was not associated with any increase in suicide attempts by relatives. We conclude that while unipolar depressive disorders are the most common affective disorders in the first-degree relatives of bipolar probands, extension of the bipolar phenotype to include bipolar spectrum disorders results in 21% of relatives having any bipolar disorder.