Medical Student Research Fellowship for Summer 2010

Mentor: Samir Gupta, MD
Department: Digestive and Liver Disease
Room number: Suite 520
Mail Code: 8887
Phone number: 214-645-6343
E-mail: samir.gupta@utsouthwestern.edu
Project title: Improving quality of recommendations for surveillance after diagnosis and removal of colorectal polyps.

Human subjects IRB approved project number (where applicable): pending

Animal subjects IRB approved project number (where applicable): n/a

Project Type (patient-based research, animal-based research, or basic research; this characterization is only to permit a general classification for grouping similar types of projects). Patient based research.

Brief Description of Project:
Title Survey of patients non-adherent to screening colonoscopy
Research question What are the reasons why patients schedule but do not complete screening colonoscopy?
Are patients who choose not to complete colonoscopy open to colorectal cancer screening with an alternate screening test?
Significance
1. Colorectal cancer is an important public health problem. Though CRC is preventable through screening, CRC remains the second leading cause of cancer death in the United States. Colonoscopy is often recommended for screening, but many patients do not complete the test after referral.
2. Reasons for non-adherence may include high cost sharing requirements for test completion (a.k.a "co-pay"), time costs associated with colonoscopy, test invasiveness, and a lack of detailed discussion with the referring physician.
3. It is unknown whether patients who do not complete a colonoscopy referral may be open to completing an alternative test such as a fecal occult blood test, which is less expensive and less invasive, but efficacious at reducing CRC death.
4. New knowledge regarding reasons patients do not complete colonoscopy, and openness to alternative tests is required.
Study design Prospective survey
Subjects
Entry Criteria
" Men and women, age 50 to 75, referred for asymptomatic CRC screening who do not either schedule or complete a scheduled test within 1 month of referral.
" No prior diagnosis of colon polyp, colorectal cancer
Sampling Design
" Consecutive patients referred for screening colonoscopy
Variables Demographics
" Age, sex, race, ethnicity, years of education
Survey variables
" Reasons for non-adherence
" Attitudes and beliefs towards colonoscopy
" Attitudes and beliefs towards an alternative screening test
" Receptiveness to incentives to promote screening (ie, removal of copay, or direct financial incentive)
Statistics 200 individuals referred for colonoscopy screening (100 at Parkland, and 100 at UT Southwestern) will be approached for survey.
Demographics, and survey responses will be characterized with descriptive statistics.

The student will aid in conducting the patient surveys and data entry, and participate in structured learning of clinical research methods. He will have the opportunity to develop a research abstract for presentation at local and national meetings, and to participate in the development of any associated manuscripts.

Previous Research Activities or Publications with Medical Students:

Molecular markers of carcinogenesis for risk stratification of individuals with colorectal polyps.
Luis Soto, summer student. Data analysis ongoing, manuscript submission pending.

Gretchen Troxler, summer student. Data analysis ongoing, manuscript submission pending. Student received a prize for her poster at the medical student research forum.

Colonoscopy utilization after elimination of copay for screening: implications for health care reform
Sherri Shabnam Khatami, MS4 research rotation student. Abstract submitted, manuscript submission pending.

Survey of patients non-adherent to screening colonoscopy
Paul "Andy" Fabela, MS4 research rotation. Research ongoing.