IMPROVING COLORECTAL CANCER SCREENING AND POLYP SURVEILLANCE DURING THE COVID-19 PANDEMIC

ABSTRACT

Introduction: Colorectal cancer screening and surveillance colonoscopy declined drastically during the initial surge of coronavirus infectious disease (COVID-19) cases in the United States. In August 2020, the state of Georgia (GA) had the highest per-capita circulating infection rate in the nation, with an average of more than 25 cases per 100,000 people and was the "most likely" state where someone may be exposed to COVID-19. Our ambulatory endoscopy unit at Emory Healthcare, which is a large, tertiary referral care center in GA had a precipitous drop in show rate for screening and surveillance colonoscopy even after elective procedures resumed. Patients cited fear of acquiring COVID-19 as the primary reason for previously cancelling their procedure. Therefore, we implemented a quality improvement project aimed at improving show rates for screening and surveillance colonoscopy by providing patients structured education via a telephone call regarding the safety of inperson colonoscopy and addressing concerns regarding COVID-19. Methods: We contacted patients between the ages of 40-75 who were due for screening or polyp surveillance colonoscopy in August via a telephone call. Patients were provided a comprehensive overview of public health guidelines regarding COVID-19, and safety precautions at Emory Healthcare to minimize risk of transmission of COVID-19 including pre-procedural testing for COVID-19, social distancing, enforcing a universal masking policy, limited visitor/escort policy, and vigorous surface disinfection. Patients who completed their procedures were asked to complete a survey to provide feedback about the impact of the study phone call using a dichotomous response of agree/disagree. Results: 161 patients were contacted, of which 49% were Caucasian, 48.4% were African-American and 1.9% were Asian. 95% of the patients who were contacted completed their colonoscopies. 91.8% agreed that they received information about COVID-19 that they were previously unaware of;81.4% agreed that they are now more likely to follow public health guidelines of social distancing, hand washing, and wearing a mask. 91.1% felt safer about procedures after the study phone call, and 90.9% agreed that they felt less anxious about the risk of acquiring COVID-19 while in our facility. 70.3% agreed that they may not have come in for their procedures if they did not receive the study phone call. 94.4% agreed that they were satisfied with the procedural protocol at our facility and would come back for another procedure if needed. Conclusions: Our study suggests that specific communication of pandemic related issues are key to reducing peri-procedural concerns about COVID-19. Failure of timely colorectal cancer screening and colonoscopy will lead to a large burden of missed polyps and colorectal cancers leading to increased morbidity and mortality from CRC.