D0180 - Appropriateness and Completion of Multitarget Stool DNA Testing in Primary and Subspecialty Care

Hyder Said, MD¹, Jeffrey Dong, MD¹, Samuel Miller, MD¹, Hannah Systrom, MD², Joseph D. Feuerstein, MD^3
1Beth Israel Deaconess Medical Center, Boston, MA; ²Beth Israel Deaconess Medical Center, Winchester, MA; ³Beth Israel Deaconess Medical Center (BIDMC), Boston, MA

Introduction: Colorectal cancer (CRC) is the third most prevalent cancer in the United States, with a 4% lifetime incidence. While more clinicians have begun ordering multitarget stool DNA (mt-sDNA) testing due to the COVID-19 pandemic, adherence to guidelines on mt-sDNA and rates of subsequent follow-up testing has not been well studied. We assessed the appropriateness of mt-sDNA orders and rate of high-quality colonoscopy completion following a positive result in a large academic medical center.

Methods: We identified patients ordered for mt-sDNA in primary care and gastroenterology clinics at our institution between April 2020 and July 2021. For each case, we reviewed the appropriateness of mt-sDNA testing, documentation of shared decision making, result of testing, and subsequent follow-up. Appropriateness was defined in accordance to the most recent American College of Gastroenterology guidelines on mt-sDNA use for CRC screening.

Results: Of the 797 patients in our study, 685 (86%) met all appropriateness criteria for mt-sDNA testing (Table 1). Shared decision making was documented in 488 (62%) cases, and the most common reason for ordering mt-SDNA was hesitancy for colonoscopy. 483 patients (61%) completed mt-sDNA testing, of which 74 cases (15%) were positive. Rates of positivity were higher in cases of “inappropriate” (28%) rather than “appropriate” (13.7%) orders (p = 0.01). Colonoscopy was ordered in 73 cases (99%) and completed by 59 patients (80%). Of the 56 patients who underwent colonoscopy at our institution, most had documentation of a high-quality colonoscopy, defined as adequate prep (84%), cecal intubation (93%), visualization of the appendiceal orifice and ileocecal valve (94%), and right colon retroflexion (83%). Sixteen patients (29%) were found with advanced adenomas and 19 (34%) had other adenomas or sessile polyps. Among the 409 patients with negative tests, a 3-year follow-up recommendation was documented for 369 patients (90%).

Discussion: Most clinicians at our institution identified appropriate patients for mt-sDNA testing and provided appropriate follow-up, and the majority of patients who underwent colonoscopy had documentation of a high-quality colonoscopy. In contrast, there were suboptimal rates of mt-sDNA completion and documentation of shared decision making.

Further studies are needed to identify barriers to documentation of shared-decision making and to completion of high-quality colonoscopies in patients being screened with mt-sDNA.



Disclosures:


Hyder Said, MD¹, Jeffrey Dong, MD¹, Samuel Miller, MD¹, Hannah Systrom, MD², Joseph D. Feuerstein, MD³. D0180 - Appropriateness and Completion of Multitarget Stool DNA Testing in Primary and Subspecialty Care, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.