Study: Women Prefer Female Colonoscopists

Newswise — A colonoscopy has the reputation of being an uncomfortable, embarrassing and even frightening experience, creating a barrier that often deters many Americans from taking advantage of this life-saving colon cancer screening tool.

A new study from the University of Michigan Health System's Division of Gastroenterology has identified yet another factor preventing or even delaying women from getting a colonoscopy: the colonoscopist's gender.

The study, published in the August issue of Gastrointestinal Endoscopy, found that 43 percent of women preferred a female colonoscopist in a primary care setting. Of those women, 87 percent said they would be willing to wait more than 30 days to get an appointment with a female colonoscopist, and 14 percent would be willing to pay more for one.

These findings, however, pose a significant challenge to efforts to increase colon cancer screening rates among Americans over the age of 50. Nationwide, approximately 8 percent of all practicing gastroenterologists in the U.S. are female.

While the average is higher at the U-M Health System, where more than one-third of gastroenterologists are female, the field needs to do more than just increase the number of female practitioners to significantly overcome barriers to colon cancer screening, says co-author Grace Elta, M.D., professor of Internal Medicine at the U-M Medical School and associate chief for clinical programs in the UMHS Division of Gastroenterology.

"Interventions must be made in the primary care setting to address the issue of gender preference and increase the participation of women in colorectal cancer screening," says Elta, director of the Medical Procedures Unit at the U-M Health System. "Programs targeting the female population should provide patients with the option to choose who they would prefer to perform the colonoscopy. Giving patients a choice may help increase adherence to colonoscopy among women, encouraging them to get screened early when colon cancer is preventable."

As the third leading cause of cancer death in the United States, colorectal cancer screening, through methods such as colonoscopy, has become increasingly important. However, fewer than 45 percent of the at-risk population has reported having undergone colon cancer screening within the past 10 years.

Researchers have previously attempted to identify the barriers that deter Americans from colon cancer screening, but none had studied whether women undergoing a colonoscopy in a primary care setting might prefer a female physician " and why.

To find out if gender preference is a barrier to colon cancer screening, lead author Stacy Menees, M.D., a clinical lecturer in the UMHS Division of Gastroenterology, along with Elta and her colleagues, surveyed 202 women during a three-month period in four of the U-M Health System's outpatient primary care facilities.

The women, aged 40 to 70, were asked to complete an anonymous 21-question survey while waiting for an appointment with their primary care physician. Women with a past history of gastrointestinal tumors, prior colon surgeries or disorders that require periodic colonoscopies were excluded from the study.

As part of the survey, participants were asked to select male, female or no preference for colonoscopy. Those who selected male or female were then asked to answer questions related to the amount of time they would be willing to wait for their preferred colonoscopist, and if they would be willing to pay more for that preference.

Participants with a gender preference for a colonoscopist also were asked if they would avoid having a colonoscopy if they were unable to select the gender of their colonoscopist. Additionally, the survey addressed other barriers to colonoscopy such as dislike of the prep test and discomfort of the procedure.

The study revealed that 43 percent of the female patients surveyed preferred a female colonoscopist, and only 1.4 percent preferred that a male physician perform the procedure. Of the women who favored a female colonoscopist, 69 percent had a female primary care physician and 27 percent had a male primary care physician.

And the survey showed that women were more than happy to wait and even pay more for their preferred colonoscopist. Eighty-seven percent of patients with a female preference and 100 percent of patients with a male gender preference for a colonoscopist were willing to wait more than 30 extra days for a colonoscopy to ensure their gender preference. Only 14 percent would pay, at most, $200 out-of-pocket for their preferred colonoscopist.

So why would so many women go to such great lengths for a female colonoscopists? Seventy-five percent felt that having a female perform the procedure would make it less embarrassing, while 50 percent responded that a colonoscopist of the same gender is more empathetic, and 36 percent felt a female physician was a better listener.

It comes as no surprise that women patients prefer women physicians to perform colonoscopies, says Menees.

"For the past 10 years, my female patients have told me that having a female physician perform a colonoscopy makes them feel more comfortable and makes the procedure less embarrassing," says Menees. "In many other fields of medicine, especially gynecology, female patients are more comfortable with female physicians, and are often more likely to undergo breast and cervical cancer screenings if their physician is a woman."

In addition to Elta and Menees, the study was co-authored by John Inadomi, M.D., and Sheryl Korsnes, MA, with the Division of Gastroenterology at the U-M Health System.

The study was supported by the UMHS Division of Gastroenterology.Reference: Gastroentinital Endoscopy, Aug. 2005, Vol. 62, No. 2.UMHS Division of Gastroenterology: http://www.med.umich.edu/gi