SURVEILLANCE COLONOSCOPY FOR LYNCH SYNDROME IN THE NORTHERN CAPE: DOES DIRECT CONTACT IMPROVE COMPLIANCE?

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Abstract

BACKGROUND:

The Annual Northern Cape Colonoscopy Outreach program provides surveillance colonoscopy to known Lynch Syndrome individuals in the Northern Cape Province of South Africa. Annual endoscopy is preceded by a preparation visit Aimed at improving attendance by directly imparting information to individuals requiring surveillance. During the preparation trip an attempt is made to reach all individuals scheduled, however due to the vastness of the Northern Cape inevitably every year some areas are not visited. Over the past few years fewer than 25% of participants obtained 100% adherence.

METHOD:

A randomised controlled crossover trial was developed to take place over two years of endoscopic surveillance. Included participants were randomised to a control group (A) that was not seen prior to colonoscopy, and a test group (B) that was visited by a team from Cape Town preceding surveillance. In the second year of study, the intervention on these groups was reversed. Compliance and understanding of information given was measured in terms of attendance at surveillance in September of each year of study.

RESULTS:

78 participants (Group A = 38; Group B = 40) were enrolled. In September 2014, thirty-six (46.2%) participants presented, 19 (50%) from the control group (Group A) and 17 (42.5%) from Group B. In 2015, there was 53% (n = 41) attendance; 21 (55%) from directly contacted Group A, and 20 (50%) from Group B. Direct interaction was found not to significantly impact attendance (p-value = 0.853). Improved attendance was noted in individuals with prior compliance to surveillance (p-value = 0.001).

CONCLUSION:

Direct interaction with Lynch Syndrome individuals prior to annual surveillance colonoscopy has not shown to positively impact attendance. Interaction and counselling should focus on individuals identified to be defaulting surveillance.