SCREEN-BE: Survey Study on Barrett's Esophagus Screening
Study Details
Study Description
Brief Summary
The goal of this study is to optimize Barrett's Esophagus (BE) screening to reduce the incidence, morbidity, and mortality of Esophageal Adenocarcinoma (EAC).
Condition or Disease | Intervention/Treatment | Phase |
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Detailed Description
The initial step to achieve this goal is to study shortcomings of the current BE screening referral processes in the United States. These shortcomings will be identified through completion of two synergistic aims that assess:, (1) provider knowledge, attitudes, and barriers to BE screening referral and (2) patient knowledge, attitudes, and barriers to completion of BE screening. The central hypothesis is that there are patient- and provider-level factors that can be modified to improve BE screening adherence. This hypothesis was formulated based on strong preliminary data demonstrating significant single-mindedness among gastroenterologists regarding BE screening criteria.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Primary Care Providers 400 eligible primary care providers (PCPs) will be recruited across the 7 participating sites to complete an anonymous survey. The survey will be distributed to eligible PCPs by the study site research coordinator via anonymous REDCap internet survey with 2 additional automated electronic reminders. There will also be opportunities for providers to complete a paper survey at PCP clinic meetings which will be collected by only the site research coordinator to maintain response anonymity. |
Behavioral: Primary Care Provider Survey
To assess PCP demographics, attitudes, and perceived barriers to BE screening, we have developed a PCP survey using a theoretical model of physician behavior based on Social Cognitive Theory and the Theory of Reasoned Action. This approach has proven effective in colorectal cancer and hepatocellular carcinoma screening. This model includes domains of provider background and experience, screening practices, perceptions of screening, physician influences, and practice environment and practice patterns. To assess PCP knowledge of BE screening, we have designed 9 clinical vignettes that will categorize provider responses into under-, appropriate, and over-use of BE screening. Survey questions and vignettes have been adapted from earlier validated surveys. Prior to distribution, the survey and vignettes will be pretested and refined based on a cognitive interview about the survey among a convenience sample of 10 PCPs.
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Gastroenterologists 100 eligible gastroenterologists (GIs) will be recruited across the 7 participating sites to complete an anonymous survey. The survey will be distributed to eligible GIs by the study site research coordinator via anonymous REDCap internet survey with 2 additional automated electronic reminders. There will also be opportunities for GIs to complete a paper survey at provider clinic meetings which will be collected by only the site research coordinator to maintain response anonymity. |
Behavioral: Gastroenterologist Survey
To assess GI demographics, attitudes, and perceived barriers to BE screening, we have developed a GI survey using a theoretical model of physician behavior based on Social Cognitive Theory and the Theory of Reasoned Action. This approach has proven effective in colorectal cancer and hepatocellular carcinoma screening. This model includes domains of provider background and experience, screening practices, perceptions of screening, physician influences, and practice environment and practice patterns. To assess GI knowledge of BE screening, we have designed 9 clinical vignettes that will categorize provider responses into under-, appropriate, and over-use of BE screening. Survey questions and vignettes have been adapted from earlier validated surveys. Prior to distribution, the survey and vignettes will be pretested and refined based on a cognitive interview about the survey among a convenience sample of 10 GIs.
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Patients 500 eligible patients will be recruited across the 7 participating sites to complete a survey. The survey will be distributed to eligible patients at the time of a clinic appointment, via telephone, or via a REDCap internet survey that will allow for 2 additional electronic phone call reminders and 1 email reminder. |
Behavioral: Patient Survey
To assess patient knowledge, attitudes, and barriers to completion of BE screening, we will use a theoretical model of patient behavior on the Health Behavior Framework to guide selection of relevant variables for survey development including 4 domains: knowledge about BE and EAC, potential barriers to BE screening completion, patient attitudes and demographic information. Prior to distribution, the survey will be refined and pretested among a sample of 10 patients with each participant completing a cognitive interview prior to distribution.
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Outcome Measures
Primary Outcome Measures
- To define provider-level knowledge, attitudes, and barriers to BE screening. [2 years]
This investigator will conduct a survey study among primary care providers and gastroenterologists at 7 large health systems in the U.S.-including 4 tertiary care referral centers and 3 safety-net health systems. Based on constructs from Social Cognitive Theory and Theory of Reasoned Action, the survey will assess provider knowledge, attitudes, and barriers to BE screening among at-risk individuals.
- To characterize the association between patient-level knowledge, attitudes, and barriers regarding BE screening. [2 years]
This investigator will conduct a survey study among patients at 7 large health systems in the U.S. Based on constructs from the Health Behavior Framework, the survey will assess patient knowledge, attitudes, and barriers to BE screening. To accomplish these study aims, this investigator has assembled a strong and diverse team with complementary areas of expertise in Barrett's esophagus, and survey research.
Eligibility Criteria
Criteria
- Patient Eligibility Criteria
Inclusion Criteria:
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Patients identified by ICD-10 codes for GERD (K21.0 and K21.9) AND
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Have had at least one outpatient clinic visit at a participating site
Exclusion Criteria:
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Prior diagnosis of BE/EAC
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Non-English speaking
- Provider Eligibility Criteria
Inclusion Criteria:
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Provider must be a PCP and/or gastroenterologist AND
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Must be at a participating site
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Denver Health Medical Center | Aurora | Colorado | United States | 80045 |
2 | University of Colorado Hospital | Aurora | Colorado | United States | 80045 |
3 | Hospital of the University of Pennsylvania | Philadelphia | Pennsylvania | United States | 19104 |
4 | Pennsylvania Hospital | Philadelphia | Pennsylvania | United States | 19104 |
5 | Pennsylvania Presbyterian Hospital | Philadelphia | Pennsylvania | United States | 19104 |
6 | Parkland Health and Hospital System | Dallas | Texas | United States | 75235 |
7 | University of Texas Southwestern Medical Center | Dallas | Texas | United States | 75390 |
Sponsors and Collaborators
- University of Colorado, Denver
- American College of Gastroenterology
Investigators
- Principal Investigator: Sachin Wani, MD, University of Colorado, Denver
Study Documents (Full-Text)
None provided.More Information
Publications
- American Gastroenterological Association, Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ. American Gastroenterological Association medical position statement on the management of Barrett's esophagus. Gastroenterology. 2011 Mar;140(3):1084-91. doi: 10.1053/j.gastro.2011.01.030.
- ASGE STANDARDS OF PRACTICE COMMITTEE, Qumseya B, Sultan S, Bain P, Jamil L, Jacobson B, Anandasabapathy S, Agrawal D, Buxbaum JL, Fishman DS, Gurudu SR, Jue TL, Kripalani S, Lee JK, Khashab MA, Naveed M, Thosani NC, Yang J, DeWitt J, Wani S; ASGE Standards of Practice Committee Chair. ASGE guideline on screening and surveillance of Barrett's esophagus. Gastrointest Endosc. 2019 Sep;90(3):335-359.e2. doi: 10.1016/j.gie.2019.05.012.
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- Menezes A, Tierney A, Yang YX, Forde KA, Bewtra M, Metz D, Ginsberg GG, Falk GW. Adherence to the 2011 American Gastroenterological Association medical position statement for the diagnosis and management of Barrett's esophagus. Dis Esophagus. 2015 Aug-Sep;28(6):538-46. doi: 10.1111/dote.12228. Epub 2014 May 21.
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- Qumseya BJ, Bukannan A, Gendy S, Ahemd Y, Sultan S, Bain P, Gross SA, Iyer P, Wani S. Systematic review and meta-analysis of prevalence and risk factors for Barrett's esophagus. Gastrointest Endosc. 2019 Nov;90(5):707-717.e1. doi: 10.1016/j.gie.2019.05.030. Epub 2019 May 29.
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- Simmons OL, Feng Y, Parikh ND, Singal AG. Primary Care Provider Practice Patterns and Barriers to Hepatocellular Carcinoma Surveillance. Clin Gastroenterol Hepatol. 2019 Mar;17(4):766-773. doi: 10.1016/j.cgh.2018.07.029. Epub 2018 Jul 26.
- Spechler SJ, Katzka DA, Fitzgerald RC. New Screening Techniques in Barrett's Esophagus: Great Ideas or Great Practice? Gastroenterology. 2018 May;154(6):1594-1601. doi: 10.1053/j.gastro.2018.03.031. Epub 2018 Mar 23. Review.
- Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ; American Gastroenterological Association. American Gastroenterological Association technical review on the management of Barrett's esophagus. Gastroenterology. 2011 Mar;140(3):e18-52; quiz e13. doi: 10.1053/j.gastro.2011.01.031. Review.
- Standards of Practice Committee, Wani S, Qumseya B, Sultan S, Agrawal D, Chandrasekhara V, Harnke B, Kothari S, McCarter M, Shaukat A, Wang A, Yang J, Dewitt J. Endoscopic eradication therapy for patients with Barrett's esophagus-associated dysplasia and intramucosal cancer. Gastrointest Endosc. 2018 Apr;87(4):907-931.e9. doi: 10.1016/j.gie.2017.10.011. Epub 2018 Feb 15.
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- Wani S, Rubenstein JH, Vieth M, Bergman J. Diagnosis and Management of Low-Grade Dysplasia in Barrett's Esophagus: Expert Review From the Clinical Practice Updates Committee of the American Gastroenterological Association. Gastroenterology. 2016 Nov;151(5):822-835. doi: 10.1053/j.gastro.2016.09.040. Epub 2016 Oct 1. Review.
- Wani S, Williams JL, Komanduri S, Muthusamy VR, Shaheen NJ. Endoscopists systematically undersample patients with long-segment Barrett's esophagus: an analysis of biopsy sampling practices from a quality improvement registry. Gastrointest Endosc. 2019 Nov;90(5):732-741.e3. doi: 10.1016/j.gie.2019.04.250. Epub 2019 May 11.
- Wani S, Williams JL, Komanduri S, Muthusamy VR, Shaheen NJ. Over-Utilization of Repeat Upper Endoscopy in Patients with Non-dysplastic Barrett's Esophagus: A Quality Registry Study. Am J Gastroenterol. 2019 Aug;114(8):1256-1264. doi: 10.14309/ajg.0000000000000184.
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