Welcome. The American Society for Gastrointestinal Endoscopy appreciates your participation in this discussion forum on Promoting the Value of Colonoscopy to Referring Physicians and Patients. My name is Eden Essex, and I will be the announcer for this presentation. Before we get started, just a few housekeeping items. There will be a question and answer session at the close of the presentation. Questions can be submitted at any time online by using the question box in the GoToWebinar panel on the right-hand side of your screen. If you do not see the GoToWebinar panel, please click the white arrow in the orange box located on the right-hand side of your screen. Please note that this presentation is being recorded and will be posted on GILeap, ASG's online learning platform. You will have ongoing access to the recording in GILeap as part of your registration. You can immediately download the handout for tonight's session from the GoToWebinar panel. Now it is my pleasure to introduce our host for this discussion, Dr. Joe Vaccari, Chair of the ASGE Practice Operations Committee and Co-Chair of the ASGE Promoting the Value of Colonoscopy Campaign. Dr. Vaccari is a practicing gastroenterologist with Rockford Gastroenterology Associates, which he joined in 1997 and for which he formerly served as the managing partner. I will now hand the presentation over to Dr. Vaccari. Thank you, Eden, and happy National Colorectal Cancer Awareness Month to all. Promoting the value of colonoscopy is something I know each of us feels passionately about, and the registration for this event surely speaks to that. During this session, a terrific panel of your peers will discuss strategies and tools to further empower you as you discuss the value of colonoscopy with referring physicians and patients. Without further ado, let's welcome Dr. Jonathan Cohen, with whom I have the pleasure of co-chairing ASGE's Value of Colonoscopy Campaign. Dr. Cohen is an ASGE Governing Board Counselor. He remains active in private gastroenterology practice in Manhattan, teaches and performs therapeutic endoscopic procedures at NYU Langone Medical Center and Lenox Hill Hospital. Jonathan, the audience is yours. Well, thanks so much, Joe, and everybody on the panel. I'm excited to join with you this evening to talk about the Value of Colonoscopy Campaign 2.0. We really started this campaign last year in large part in response to members excited about what can we do to really promote the value of colonoscopy in the context of a lot of promotion by non-colonoscopic screening methods out there. And so we got started with it last year, and this fall, after we really started to get a hold of reopening practices after the beginning of the COVID pandemic, we retooled the initiative. And we want to tell you tonight a little bit about where that is. So again, we're still focusing on promoting the exceptional value of colonoscopy, and our two target audiences are really primary care physicians and the public, and creating resources for gastroenterologists, particularly, to be able to use that with their constituents, the primary referring doctors, and also to promote to the public. We also have a wide array of industry partners that share the mission. They're aligned with some of the themes that we're trying to promote in cancer prevention. We've had two summits, and they've been involved, and a number of them are trying to work together with us, particularly in this month. We decided to break up the messaging into a number of thematic pillars. And you'll see, when you see the website and look at what new content we've been putting on it, it focuses around these pillars. So we want to, first of all, focus on not just the screening benefit of colonoscopy, but also the fact that this is the test that prevents cancer through polypectomy. Second, the theme is that this is a safe prevention test and should not be delayed during a pandemic. And this was particularly important, we think, this fall, and continues to be an important message. We then want to focus on the fact that colonoscopy is critical as an evaluation tool in high-risk groups and defining what those groups are, and especially where colonoscopy is really the one test that's indicated in that regard. We take particular interest in the individuals younger than the recommended screening age and in the presence of symptoms, the role of colonoscopy. Another very important theme is the idea of health equity and ensuring equity and access to high-quality colorectal screening and prevention in underserved communities, including barriers to colonoscopy as a screening tool and in following up a positive fit when that's used. Last theme is looking at data that supports colonoscopy as the time and cost-efficient colorectal cancer prevention test of choice. So these are some of the themes that we're trying to collect great information on, both for the public facing and also as resources for you and our members to promote among your referring physicians. We'll see a little bit of the website later. Eden's going to go and take us on a little tour as we hear some of the other presentations. We're trying from now on for the next 12 months to really focus on getting a regular social media presence to try and do some direct outreach to patients, as well as outreach to press, which has already been going on, an advertising campaign, partnering with medical associations, and also trying to look for volunteers among our membership to try and do better grassroots outreach to primary care doctors and to give presentations in which we're going to have materials available. If anyone on the call is interested in participating, please contact the organizers of this event or Andrea Lee at asglee.org. We're definitely looking for ways in which our members can also contribute to the campaign. Just by way of some examples, one of the things we're doing with content, we're having a number of video interviews with prominent authors on papers that they've written that focus on some of those themes and to bring out in short snippets really some of the key themes like the cost effectiveness of screening, the optimal timing and approach to preventing colon cancer, the issues on reaching underserved communities. So, we're going to have specific content in these areas, as well as videos, as well as we'll be seeing later on customizable safety materials, and we'll be also having educational videos geared at the PCPs, including how to keep colonoscopy safe and strategies to promote colonoscopy. We'll also be doing some of those journal scans that have been really very popular from the ASG. We're going to put the ones related to colorectal cancer screening available on our landing page. So, this landing page of our site will be a place where anyone interested in preventing colon cancer can start with and find all the information that they want. So, with that, I'm going to turn it back to Joe at that overview, and maybe we can talk later about this in the discussion. Thanks so much. Thank you very much, Jonathan, for that excellent introduction to the VOC campaign. As we move to our next presenters, on screen, we will go to the ASGE website and straight to the Value of Colonoscopy campaign to showcase in real time the resources ASG has available to you as the presenters discuss the strategies for deploying them. First, I will call upon my colleague, Dr. Aaron Shields, to start the discussion on strategies and educational tools to promote colonoscopy. Dr. Shields joined Rockford Gastroenterology Associates in 2004 and currently serves as managing partner. He is a member of the ASGE Reimbursement Committee and previously served on the ASGE Health and Public Policy Committee. Aaron, the audience is yours. Well, thanks, Joe. You know, I'm excited to have this opportunity to talk about some of the specific strategies that we've taken here to really promote the value of colonoscopy in the Rockford area. Just for a little context, we are a 14-physician, seven APP practice in Northern Illinois that serves a population of about 300,000. And what we've really focused on is trying to understand the needs of our community, specifically with regards to colon cancer screening. And so data being king, we follow very closely the referral patterns and the number of patients that get referred for both screening and for just symptomatic evaluation. And what we noticed in 2018-2019 is that while our overall book of business was increased, we were seeing more patients referred for symptomatic evaluation, the number of referrals for screening colonoscopy was actually decreasing. And of course, that made us wonder what the underlying currents were that were causing this. This occurred around the same time that we started to see more patients showing up for evaluation of positive multi-target stool DNA testing. And of course, this paralleled very closely with the increase in the marketing by the makers of the stool DNA test, both to primary care providers, as well as direct to patient marketing, which of course, continues to this day. So we wanted to try to determine if there was a connection between our lower number of screening referrals and the higher number of patients sent for stool DNA testing. And one way we did that was to talk to our patients when they came in for colonoscopy after a positive stool DNA test. And there were a couple of questions that we asked each of the patients. And the first was we wanted to know what sort of discussion was had at the time that they decided which colorectal cancer screening test to undergo. And the majority of time there was minimal or no discussion. The patients were just advised that there was this stool DNA test that they should undergo, but there wasn't any meaningful discussion regarding the pluses and minuses of this test versus other tests. We would also then ask what sort of discussion took place after your test came back positive. And the vast majority of patients had no idea what a positive test could really mean. And so this obviously raised concerns for two reasons. The patients who showed up with a positive test didn't really understand what it meant. But probably more concerning is if we assume that the primary care providers weren't having a meaningful discussion for those that tested positive, they were probably also not having a reasonable discussion for a lot of the patients that ultimately tested negative. And as we all know, there's a significant false negative rate associated with this test. And that made us concerned that there was a growing cohort of patients who had been reassured that they had essentially a negative colorectal cancer screening test without really understanding the true implications of that test. So we opted for kind of a two-pronged approach to try to fix this, what we viewed as a kind of a knowledge or education gap with our patients. The first was outreach to the primary care providers and Dr. Nunevsky and his discussion is going to talk about how we did that. But we also opted to do direct patient and community education efforts. Obviously our thought being if the makers of people advocating colorectal cancer screening tests outside of colonoscopy are targeting both primary care providers as well as patients in the community that we needed to do the same thing. So one of the ways that we did that was through the media. An editorial was written last year during Colorectal Cancer Awareness Month. It was sent to the local print and electronic newspaper. It was also posted on our Facebook page during the month of March. And we will be posting a similar editorial opinion piece, actually it's coming out this weekend. And there were, this was really targeted to directly at the level of patient education. And so the first part was to emphasize the value of colonoscopy in preventing colon cancer. To talk about its safety, its accuracy, how it is the only test that can truly prevent colon cancer. In the version that will be coming out this week, we also emphasize the importance of not delaying it in the midst of a pandemic and that it is a safe test that institutions are performing with a minimal risk of transmission. And then the article focused on some of the limitations of stool DNA testing. We talked about the limited sensitivity and how it can miss cancers or even 60% of large polyps, the false positive rate, and how choosing a stool DNA test first may affect the cost of the subsequent colonoscopy. We focused on the fact that it is, according to the U.S. Preventative Task Force, it's a Tier 2 test, and that it has been shown in studies to be less cost effective than other screening tests. And so this was something that remained on our Facebook page for an extended period of time and did circulate through the local media. Now, the effect, of course, it's a little hard to assess in the midst of the COVID pandemic because any changes in referral patterns now are much more difficult to interpret. But what we've noticed towards the end of last year and this year, even the middle of last year and this year, is that our referrals for screening colonoscopy have rebounded. And they're actually more than, they're approximately 10% greater than they were in the pre-pandemic levels. Again, we're not sure how much of that is catch up from patients who didn't have the procedure last year, but we like to think that some of our outreach efforts have had a positive effect in terms of making sure patients understand the value of screening. Of colonoscopy. Joe, I'll hand it back to you now. Thank you, Aaron. Now let's welcome Dr. Ilchane Inovsky to continue the discussion on strategies and educational tools to promote colonoscopy. Dr. Inovsky joined Rockford Gastroenterology Associates in 2008, and since 2015 has served as chief financial officer of Rockford Gastroenterology Associates, leading several initiatives to deliver the highest quality care to our community. Ilchane, the proverbial floor is yours. Thank you, Joe. And thanks to the ASGE for allowing me some time today to talk about some very important topics. As Dr. Shields had already mentioned, we are taking a multifaceted approach to delivering the message that colonoscopy is the gold standard. And one of the things that we have to of course consider is the fact that millions of patients who are eligible for screening aren't getting screening. And it's always been our contention that any screening is better than no screening, but it's important for our patients and our primary care providers to understand the strengths and limitations of the various screening tools. And of course, since stool DNA testing has become more widespread, there's obviously a larger marketing effort. We wanted to make sure that patients in the community understood the role that those tests play, while at the same time emphasizing that colonoscopy is and remains the gold standard. The approach that we take to inform our community is really three-pronged. As Dr. Shields had mentioned, he had started the outreach with a letter to the press outlining some important facts about colon cancer, colonoscopy, stool DNA, and obviously its role in the screening armamentarium. But one of the things that I had focused my attention on was trying to get in front of our primary care doctors as frequently as possible to go over some important information, to give everybody an update on what's going on in colon cancer epidemiology. I think most PCPs are aware that colon cancer remains one of the highest causes of colon, second leading cause of cancer death, and third most common cancer. But my slide deck, which is available on the ASGE website, just provides just some easy background for them to see what the pearls from the basic discussion about epidemiology to famous patients with infamous cancers, to discussing some of the screening successes and focusing on the fact that colonoscopy has been successful in reducing colon cancer in our population, but also tempering that enthusiasm with the understanding that we're still losing 50,000 patients a year to a cancer that is entirely preventable with a high-quality colonoscopy. So I cover these points. I do focus some attention on the various screening tools based on the U.S. Multi-Society Task Force recommendations, of course, focusing on FIT, then stool DNA, and then colonoscopy, looking at the various sensitivity specificities, positive predictive and negative predictive values, respectively, informing them so the community understands what we're thinking and what we're telling our patients. What I didn't include in the slide deck and what I think is worth including if you decided to use the slide deck to build on your context with your PCPs is we also focus on our group's adenoma detection rate and complication rates. And patients will often come to their PCPs afraid to have a colonoscopy because they have a risk of perforation when we tell them that our risk is quite low and way below what's considered acceptable. Patients get some, I'm sorry, the PCPs get, I think, some confidence that when they refer them to us, they can provide some information about the safety. So that's the one approach. That is the approach to getting to the PCPs. The second approach has been to really advocate connecting with our patients on social media. So RGA has a Facebook page that is prolific. We've partnered with a local marketing team with experience in the healthcare space, and we post social media posts, of course, with Colorectal Cancer Awareness Month happening now. We're focusing on a combination of funny posts. For example, this week we had, if your first game console was an Atari, it's time to get a colonoscopy. We're adding those kinds of memes through the course of the month. But we also know through our marketing research analysis that patients do get motivated when they see images of concern, meaning are my symptoms serious, and describing to them that colon cancer kills. So our theme for this quarter is no excuses, get screened. So when you go to our Facebook page, you will see that prominently displayed in addition to saying don't ignore your symptoms. Our marketing approach also includes an email campaign where we distribute 25,000 emails to our target market, highlighting not only colonoscopy and colon cancer, but other things that we think are relevant so that we can build a connection with our patient, our consumer of healthcare, if you will. And then the last point is I think that direct frequent engagement with our patients is going to be key. So before a patient shows up, before I see my patients in prep for screening, what I tell them is they've chosen the best tests that can prevent colon cancer, and I highlight some of the available and more highly marketed stool-based testing and some of the strengths and limitations of that. As part of our discharge paperwork, every patient receives a two-page summary sheet about highlighting the multi-society task force recommendations, the emphasis on colonoscopy as the first test of choice, as well as highlighting some of the strengths and limitations of the stool-based testing that Dr. Shields had mentioned. So while it's difficult to quantify the success of these efforts, I think anecdotally patients have been more verbal about their understanding of colonoscopy as well as stool-based testing and the strengths and limitations of various tests. And we hope that, of course, with this multifaceted approach that we can continue to display and emphasize and champion the value of colonoscopy as the best test. Thank you. Thank you, Ilche. Let's move to the critical topic of safety. As we begin to see the light at the end of the tunnel, after what we would all agree has been a tremendously difficult year, we need to ensure patients feel confident in returning to routine care. It is my pleasure to introduce Erika Natal, who will discuss the safety video available to you. Erika is a registered nurse with an MBA and MHA with extensive experience in quality, accreditation, and health care management. She has spent the last 11 years at Rockford Gastroenterology, where she's the clinical administrator. Erika, thank you for starting our safety discussion. Hello, everyone. I'm happy to be here with you tonight. I wanted to talk a little bit about the safety video that has been developed and that you can find and use on the ASGE.org website under the For Patients tab. This video showcases the response to safely treating patients during the COVID-19 pandemic. We felt it was important to acknowledge that people are hesitant to seek in-person care and get the message out that the GI community is prepared to offer care safely. The video highlights several practices that have been taken to prevent the transmission of COVID-19. We thought it would be nice to walk the viewer through the path that patients take during a typical procedure appointment. So we begin the video by talking about the scheduling process and the use of COVID questionnaires to screen patients out for appropriate inpatient visits, along with temperature checks and things like social distancing, allowing drivers to wait in the car to limit patients in waiting rooms. As we guide them past that waiting room, we go into our prep area where we discuss appropriate spacing between patient bays, cleaning practices that need to take place. There's a lot of emphasis on having on hand the appropriate PPE in sufficient quantities. We know that this was something that received a lot of media play and that patients are very concerned about. At our practice, a common question from patients was related to the cleaning of the endoscope itself. They wanted to know what we were doing to make sure that the scope wasn't going to be infected with COVID-19 and how we were going to keep them safe. So the video touches a little bit about how high-level disinfectant that is normally and routinely done after any procedure is effective on the COVID-19 virus. We've included a short case study that really emphasizes the importance to keep appointments and not to delay care. It really emphasized that preventative care is a gift because when disease is found early, there tends to be more treatment options and better outcomes. So the video finishes with a plea to patients to keep those appointments, to get their screening, and to make sure that if they are having symptoms, they do come in and seek care. Back to you, Dr. Bakeri. Thank you, Erika, and I will encourage all of you to take a look at this video. It's really well done and I think will have a great positive impact on patients and hopefully get them over that fear barrier and back into your practices to undergo colonoscopy. Well, let's continue the safety discussion with Nancy Schlossberg. Nancy is a digestive health consultant with John Muir Health in Walnut Creek, California. She has been a gastroenterology and endoscopy nurse for more than three decades, filling a variety of staff, management, business development, and leadership roles in hospital and ambulatory settings. Nancy is a past president of the Society of Gastroenterology Nurses and Associates. Nancy, the audience is yours. Okay, thank you. Hi, everybody. So as we do this, I think we're going to walk through these posters just to give you a little bit of an idea. I just want to preface this by saying putting these posters and other tools together was really a lot of fun and very, very necessary. I think every endoscopy unit said safety is top priority. There's just heightened awareness now, which these customizable materials capitalize on now and as we move beyond COVID-19. So you'll see there's PDF and Word versions that you can customize. So just to piggyback on to what Erica said, patients are always apprehensive even if it's their first or their fifth colonoscopy for reasons, do I have cancer? Did it return? They always want to know how long will it take? When can I eat again? When will I know the results? Will it hurt? Will I feel anything? And I used to say patients want to know how we clean the scope. That's the one that they really didn't ask. But now the bigger safety question is how will you keep me and the scope COVID safe? After instructing me, you've already scared me to death that something may be poked up through my nose and into my brain and it's drop and go. Nobody can come in with me and hear the results. So the first safety poster, which is safety information for endoscopy patients, was developed to allay the patient's safety and COVID fears up front. So you're moving through that now and that's the PDF version. And if you'd like to just flip into what the customizable one looks like, that would be great. You can get black and white or you can get it in color. And as we did this, we said, well, patients are used to seeing icons in general. It's everywhere now, wear your mask, wash your hands. But these are tailored to safety in the endoscopy setting. So I think there are lots of creative ways to use these, especially as patients are returning to in-person PCP visits. And we're seeing more and more of that video visits are still there, but people are now coming in. They're not so afraid to come in and see their physician. So I think other ways, when we talked about this, that if you send out in snail mail, prep instructions, you could put it in there. If it's like us on MyChart where you have to click in and get all your instructions, you can put it right in there. You can post it on your facility's website. You can add to any other marches, colorectal cancer awareness month, promotion and marketing. If your nurses belong to their SG&A regional society, ask them to post it on their website. So multiple ways you can use it. So let's take a look at keeping your patients safe during COVID-19 and beyond. That was the next one. That was, if you go back to the website, hit that one. Yep. All right. And this one is patients want to know who's taking care of them. It's nice to give them the good housekeeping seal of approval options. And again, emphasizing that we have patient safety and comfort in mind. And this is a great waiting room poster. And it was amazing as we put this together, how many certifications, accreditations, recognitions, and registries are out there that people don't realize as you put that all together, what you got. And I say, you got them, flunk them. And so we went through an amazing list of those. And again, there's references on the bottom to check out that we're not alone in this. Other people have written about this. And finally, let's just move on to the scheduler facts. And if you go down on that one. So when I socialized this one with our lead scheduler, she was so excited to have talking points. And she told me that the schedulers and the medical assistants get these questions all the time. And we don't necessarily have schedulers and medical assistants dedicated to colorectal cancer screening. And we do a large volume of open access colonoscopy. So the patients don't always know what to expect. And the schedulers and the MAs don't exactly know what to talk to them after they finish talking about their prep and all the other things that have to happen before their appointment. So this one I really like, and this one's been in use, all the talking points in here. So all of the resources or tools that enhance the patient experience and make them feel safe and secure and follow up at the right intervals. And of course, you want our patients at the end of the day, when you use all this, is to tell a friend and get screened at your facility. So those are those, and those are very easy to use. And if you have other things that you want to add, feel free. But again, it's nice to have things that are there that you can offer that they're your tools to use for your patients, however you best want to do that. Thank you, Nancy. And thank you to each of our presenters for walking us through the resources available through ASGE's Value of Colonoscopy campaign. We will take the balance of our time continuing the discussion on outreach and taking your questions. While Eden starts to collate the questions, I actually received a question earlier this week by email, and I'll start with that question. I'll send it John's way. It's a two-part question, John. The first part, is there a plan to create a presentation using Ilche's slide deck that could be accessed on demand from the VOC website? And secondly, if such a lecture or presentation is created, any recommendations on how it can be used by gastroenterologists to their primary physicians? Okay, so first of all, thanks. And by the way, those are great presentations. I'm looking forward to the discussion. And really very practical about how we can actually take these materials that we're putting together and use them. To make it more useful, this great presentation that's on the website, what we're going to do is two things. We're going to have a version where it's narrated, where someone can just view the presentation as an entirety and could perhaps share that with a primary care referring doctor. Or one could actually invite the doctor to go and look at it on the website. But we'd also like to do is we have some slides there. We're going to do some voice to text and actually create speaker's notes. So that one could take the slides with the speaker's notes to actually allow someone else to present that to their own referring doctors or getting their own communities. Because I think it's real important to sort of really get into the grassroots with this. So we're going to do that with that presentation. And we're going to have a number of other presentations, some that are already there and some that are being developed right now to try and do the same things. We have two versions of it. And I think that the idea would be we would also like to, again, we're going to try and pilot out getting some individual GIs to volunteer to go into some of their communities and try it out with these presentations and see if they're able to perhaps go to a family practitioner program and see if they can get on their family practice grand rounds schedule or perhaps present one evening to some referring physicians. So we're open for suggestions and ideas from the community of gastroenterologists of how to best get this out there. But we want to have a variety of resources in a variety of formats, both the long format and also we'll have some of these video presentations that we have, these conversations where we're talking with an author. Maybe some of that content might be shared in smaller duration with some of the referring doctors. Okay, great, John. Thank you very much. Eden, I'll turn it back to you for the question and answer session to begin. Wonderful. And if I could make a request, if the presenters wouldn't mind turning on their cameras during the Q&A session, that way we're going to go ahead and leave the website up so that folks can see both the website in case you make any other references to it and they can see your fabulous faces as well. So let's see if I can get the website going up there. And I'd like to direct the first question to Dr. Shields and then if the other physicians would like to chime in as well. Dr. Shields, what is the false negative rate of the stool DNA test? Well, so it depends what you're talking about in terms of what you're looking at. So for colon cancer, the false negative rate is about 8%. So stool DNA testing will identify a colon cancer 92% of the time, 8% of the time it will miss it. The, for large polyps, it's, and we say large meaning larger than a centimeter or with advanced features, the false negative rate is approximately 60%. And so it's that group of patients that really has us concerned. 4 million, I think I heard 4 million stool DNA tests have now been performed in this country. And I believe that a significant number of those patients have advanced neoplasia, whether it's a large polyp or even a cancer, but has left the office with a false sense of security. And I believe that is my opinion is that's ultimately going to be one of the shortcomings of this test is that we are going to start seeing colon cancers showing up in patients who had, you know, had a negative test. That's not to say that other screening tests aren't, are perfect. We know that even colonoscopy can miss lesions, but it's certainly not, certainly has much better sensitivity as well as the ability to, to prevent colon cancer. So I think, I think that's the, hopefully I answered the right question and got the numbers that you were looking for. John, any comments? Yeah. Yeah. I would like to say something, speak to the duration of protection from a test. Now, say you go and get a test with a 92% sensitivity and you don't have, if you have nothing, it turns up, say you have a seven or eight millimeter or even a 10 millimeter polyp, you know, yes, you may not get the 10 years of protection that you'd have with a negative colonoscopy. So that goes to this issue of the efficiency of screening, but is the person going to come back in three years for another, a non-colonoscopic test? That's uncertain. And so that again, there's opportunities for people perhaps to fall through, through the cracks. And I think that's compelling. The other issue is the minute we start talking about symptoms or high risk groups for early onset colon cancer, and there's some, you know, there's some, a number of those, you know, risk factors besides family history. I think that, I think it really changes the equation quite a bit. Thank you, John. Any comments? To build on that, and one of the things we worry about is not only the high risk patients that you mentioned, Dr. Cohen, but one of our partners, Dr. Matthew Steer had led a study that we're presenting. He's presenting it as an oral presentation at a DDW that showed that in our community, one out of six or 15% of stool-based DNA testing was inappropriately ordered. So these are patients that perhaps had high risk features, had family history, had a personal history who were still getting the test. So 15% is not a small number. And that's what our efforts should be to inform patients that, you know, there obviously are options, but if you have any high risk features, we need to discuss them to make sure you're getting the right test, which would be the colonoscopy. Thank you, Aaron. Sorry, go ahead, Aaron. Just to add one more thing to that. I think, you know, the marketing campaign for the stool DNA testing has been very aggressive at multiple levels, both through the primary care providers as well as to patients. And I think one of the things that has surprised the primary care providers is just what the actual numbers are with regards to the accuracy of the test. And when we've had discussions with them, I think some of them have been a bit surprised that it isn't better for certain lesions. And, you know, I think it's opened their eyes a little bit, these discussions that we've had, this additional work that especially Ilche has done and getting the information there that it's useful to them, it's useful to our patients. And it's an effort worth doing for your practice as well. Obviously, the patients come first, but it's an important practice issue. Thank you, John, Aaron, and Ilche. Eden, next question, please. Yeah, just to follow up on that, are we aware of any lawsuits that have been associated with those false negatives? I'm not aware of any. Anyone, John, Aaron, Ilche? No, I do believe it is just surely based on the numbers. Again, if there are 4 million tests that are out there, that sort of thing may be coming down the road. And unless people really adhere closely to, you know, getting this done every three years, and even if they do, there are clearly going to be interval cancers that come up in somebody who's had a negative, you know, multi-target stool DNA test. So it wouldn't surprise me if we do see that in the future. Next question, please, Eden. Sure. So someone is asking if the videos are customizable, and if they are not customizable, could somebody essentially take the points from the videos and produce their own? Jonathan, can I throw that your way? Yes. We have a patient-facing part of the website and a physician-facing part, and I think that the physician-facing has really some materials, as we saw, that you can put your boilerplate on with some disclaimers, is that these are not, you know, they're not to be, they will, if they amend them, that they're taking on some of the liability themselves. But I think that the idea is it's for our GI community to be able to put the boilerplate of their own practice on it. And for example, say you are not doing COVID testing on every patient before they come in, like we are in many places around the country are. So you don't want to have an icon on your document that that's what you're doing. So I think that that's the idea behind it. But the videos and the presentations aren't going to be amended, and I think they're only going to be given by members of our own community. And, you know, I don't think that there's any way around, you're going to make slides available for people to present. I think that, you know, they, I don't know a way to copyright, unless you use a, even a PDF might be amended, but I think we could, it's not as useful to give as a PDF, but that's an interesting idea. We might be able to make the slide decks as PDFs that can be presented with, but can't be altered as easily. So that's a great idea. Okay. Eden, next question, please. So our next question is for Nancy. So Nancy, will these materials, do you feel that they are enduring? Have these been prepared to be enduring materials that could live on past COVID beyond the pandemic? Absolutely. If you look at them, especially because they're customizable, obviously, I mean, who knows how long patients may need to be COVID tested before they come in. And who knows when patients, it's not going to be drop and go anymore. So you can take all that out. But I think it's so important to promote this safety because patients will say, well, I'd rather get cancer than have a colonoscopy. The prep's the worst thing. It was the worst experience I've ever had. And I think the more upfront you can set expectations that this, it doesn't hurt. We're going to take great care of you. And it's important to have this done because it is the best test. And guess what? You might not have to come back for 10 years. And by that time, maybe we'll have something else. But in any case, these are enduring and you can take what you need out of them. And then there may be something that you want to add that's particular to your practice that makes sense to your patient population. Erica, any thoughts about the video being enduring with some changes and manipulating? I think that, you know, post-COVID, there definitely would need to be some aspects of it that come out. But so much of the video really speaks to just good infection control practices. Perfect. That's what I was trying to get at. So great. Thank you. Eden, next question, please. And we'll start with Erica on this one. Erica, have you had any patients who during their time after the procedure, their anxiety mounted? And even though you had all the right safety precautions in place, they became very anxious. And how did you handle those patients if you did experience that? We experienced just a handful of patients who tested negative, came in, had their procedure, and within, you know, a short period of time felt that they had symptoms and perhaps they acquired it while they were here. Fortunately, none of those patients actually had COVID. They were going off of symptoms, but it really has to do with education, reassuring them that all of the infection control measures were properly adhered to, going over what their symptoms are, helping them to understand that they can go to their primary care physician or another testing site and repeat those tests and that we were willing to listen to them and talk to them at a later date. So absolutely, I think that patients start to sniffle or cough or have symptoms for any other reason and their mind does trigger and go back to, I must have got it at the doctor's office. So I think that being open and transparent and being willing to listen to them and answer those questions really goes a long way. Very good. Thank you, Erica. Next question, please, Eden. Sure. We'll direct this one to Dr. Cohen. Dr. Cohen, this person asked, how can I engage patients in the value of colonoscopy campaign? I have some patients that I've grown very close to and they're very engaged and they would be great promoters of this campaign. Great. I've had patients like that myself and that are extremely grateful if you've diagnosed something, particularly, you know, an early, especially the early onset, you know, colon polyps that we talked about. We have a mechanism by which, and it's on the website, where gastroenterologists, if they have a patient they think might be willing to share their story, can, with their permission, you know, get us, give us the opportunity to reach out to them and ask them to help give their testimonial. I think testimonials are really quite compelling. And I think not just from patients, I would think from physicians and nurses as well during this whole past year, I think the stories that people can tell are, you know, as compelling as some of the data that Ilche is, you know, is gonna be presenting and sharing, especially when it would come in with social media and marketing to other patients. Speaking of Ilche, we have a question for you, Ilche. In feedback from patients who had their initial screening, non-colonoscopy screening, so some other test, what were the biggest barriers experienced by the patient to choosing colonoscopy as their first test? So they had a FIT test or a multi-targeted stool DNA and not colonoscopy. What's been your sense on the barriers? Yeah, I think that we all have patients that no matter what you tried to tell them, no matter how you convey how safe and effective and appropriate a colonoscopy would be, there's no way they're getting it. And I think in those cases, a stool-based test would provide some screening. Again, going back to this adage that any screening is better than no screening. So many times, I'm sure you'll also speak to this, everyone that, you know, we'll have patients that are reluctant to get the colonoscopy, get the stool test, the test is positive. As they're agonizing for one or two weeks before we can get them in for the colonoscopy, they start doing research. And then they have this epiphany and the discovery about what really the stool test meant and what some of the limitations are. And so I think that those people then become obviously convinced that moving forward that they're gonna be advocating for colonoscopy as the preferred test, understanding that their particular experience. You know, I think that there's always gonna be some reluctance and people find the convenience factor. There's still people, patients who are obviously conscientious about coming in. There's also people talking, patients will say, you know, I can't take time off work. There are logistical aspects with having to take time off for your colonoscopy and both the day before and the day after. But I think when they're choosing, say, stool-based testing, I think most of it comes, as Erin mentioned, from being offered a test, much easier to say, here's a stool test, we'll send it, the box gets checked, the primary care provider gets the credit for doing the screening with not as much discussion, perhaps, as there should be. And then the patients come out feeling like they've done their part. So those are the kind of the couple aspects that I've seen in our experience. Erin, can you speak to that? Erin, go ahead, please. Any additional thoughts? No, I think, you know, I think if the discussion doesn't happen, you know, with the primary care provider or whoever's sending the patient for their screening test, then it doesn't matter how good our test is, you know, the marketing blitz and the, it's been very strong and, you know, patients know about the, you know, the box and they know about this test that is really easy. And, you know, if the patient doesn't get the information about, you know, what the true accuracy of that test is as compared to colonoscopy or as compared to annual FIT testing, it's gonna seem like the best option. And, you know, in our discussion with our patients, that's, a lot of times that's the answer we get. Well, there wasn't any meaningful discussion. It actually truly wasn't informed consent on, well, not really informed consent, but it wasn't a true amount of information given to the patient to allow them to make an educated decision. It was more just, well, this is an easy test, let's go do this and it's done. And, you know, part of it may be a time constraint. I understand if you're busy in the office and, you know, a lot of these patients need, it is a longer discussion that has to take place if you really want to dig a little deeper into the numbers. But so, you know, the focus of a lot of what we do is to try to encourage that discussion to take place, whether it's through talking to the primary care provider or just directly telling, you know, the individuals, you need to have this discussion. If you don't have the discussion, then you don't have the information you need to make the right test. So we really push to, you know, make sure you get that discussion before you actually make this decision. Very good, thanks, Aaron. Eden, with your permission, I actually have a couple of questions that came my way. Of course, I wouldn't do it without your permission. Always standing. I'll start with John. John, how do we hope the VOC, when I say how do we hope the VOC campaign will address health equity concerns as it relates to screening for colonoscopy and screening for colon cancer, and specifically with colonoscopy, which we describe as the colon cancer prevention test? Thanks, Joe. This is an extremely important area, and that's why, you know, it's we've made it in one of our pillars of the campaign, and we have a lot of really great people working on trying to both develop specific content to give the kind of data that we can get out, as we were talking earlier, about barriers to colorectal cancer screening and to colonoscopy. Also, does this deal with the giant health equity, you know, issue and crisis we have with the over 40% increase in colorectal cancer mortality among African-Americans compared to non-Hispanic whites? And there's so many different aspects of it that are so important. We think that we need to be looking into the weeds and what the specific barriers are to colonoscopy, for example. Is it getting access to preps? Is it transportation? Is it, you know, are there some, you know, are there ways to get into community practices to be able to get the words out that are different to make sure we can get the word out? But so we know that it's a priority, and we're trying to get some really good content out there. And then again, I think this effort to get into the grassroots and make proactive efforts, as Aaron said, to share information with the PCPs, I think will be particularly important. You know, it's very hard to get to the public with limited budgets. I think that you're gonna also take advantage of ASG's social media growing presence and our social media task force to help get the word out in a format that might be conducive to the public. So we're trying to really figure that out. Lastly, our industry supporters are totally aligned in this theme, and they are also very interested in figuring out how they can work to us with using their social media efforts to also try and to approach this aspect of the campaign. Thank you, John. Aaron, the next question's for you. During your presentation, you mentioned your editorial. Is that on the VOC website? And if it is not, is there a way that it could be put on the website? Yeah, I think the plan is to take the editorial, the opinion piece for last year and probably for this year's as well, and make it available for ASG members to look at, to model. There's certainly nothing proprietary in there. If somebody wants to use it and just modify a few names, and it's a very general article anyway, yeah, it'll be available. We're working on that. Very good. Thank you. Eden, back to you. Next question, please. Sure. Our next question is for Dr. Nonevesky. So this person is asking for any tips that you might have in approaching referring physicians with whom you do not have a preexisting relationship. So do you have any tips or tricks for people? I think just establishing a connection. Our worlds are so fragmented these days with the electronic medical record, and physicians retire, new physicians come in, and primary care providers, nurse practitioners, physicians assistants. The key is to, of course, try to provide the best care so that your reputation is strong with the community that you're serving in. What I typically do is if I see a new referral from a new PCP that I don't know, I have a letter, a template that I have in our EMR that I will generate at the same time as I do the screening colonoscopy. And I'll say, thank you for referring this patient. This is some of the highlights. This is what we do at Rockford Gastroenterology Associates to care for your patients. I also try to embed information about the various screening tests, including stool-based testing, into the notes that we send to our PCP so that they can read them and get some information from it. The days of hanging out at the hospital physician lounges are long gone. So those kinds of relationships aren't as good. Those kinds of relationship buildings aren't as strong. So you make connections at grand rounds and various meetings and then becoming colleagues on various social media, various business platforms like Doximity or LinkedIn so you can have some connection and be able to promote what you believe in and convey the importance of whatever we're focusing on, in this case, colonoscopy. Thank you, Elche. Next question, please, Eden. So I think this question really follows up to that. Do we have any tips or tricks? Maybe we'll start with Dr. Shields on this one for social media on promoting your practice on social media and the value of colonoscopy campaign. I'm going to save Aaron maybe a little headache because Elche is our social media guy. I'm going to throw that one right back to Elche. Thank you for sparing me, Ellen. There's only so much that a busy physician or practice can handle. And we've been fortunate to partner with a marketing firm that understands the healthcare space. And so we have a committee specifically dedicated for marketing that includes me and two other physicians. And we have monthly meetings with our connection at that firm. And so they don't understand GI the way that we do. So our responsibility is to present them with content and information and then let them put things together. We've decided initially, and we're going to be expanding in the near future to focus on Facebook because we think that's been our target demographic. But over time, we're going to be moving towards Twitter. We're a little bit behind on that. And then Instagram, eventually. It's not very hard to do once you get established. The key is to, if you don't have a Facebook presence, for example, using Facebook is to make sure you own your and claim your identity. What will happen is patients or someone will check in at Rockford Gastroenterology Associates. And before we got on social on Facebook, our name was already out there. So we had to submit to Facebook that we own, we are the business that people are checking into, own it. And then as all of us are aware, material is key. So we are having posts every two to three days on a variety of topics. Colonoscopy being, of course, important ones this month, but on, could it be celiac? Could it be Crohn's? Understanding GERD? We have an interstim program that we're advocating that we're trying to inform our patients. And what's interesting is that we are, I'm an administrator on our Facebook, so we can see where the blasts are going and see who's liking them and then asking them to like the page and then building on that. But if you don't have any facility with social, if you have the resources, partnering with a marketing firm that has knowledge and expertise in this particular space is an invaluable tool to do. Yeah, and I can tell you, I think this has been money very well spent for our practice. And it took us a while to get there, but as Ilche said, we're expanding, coming up. And I think, again, it's going to be money well spent. Thanks, Ilche. Eden, next question, please. Yes. Are we encouraging our members to link their website to the Value of Colonoscopy campaign or how best can they tap into this resource? John, I'll throw that to you. So, sorry, Eden, could you restate that? Sure. So basically I think what they're asking is, are we supportive of our members linking straight into our Value of Colonoscopy page or how else can they kind of capitalize on what we're doing in terms of maybe making links between their webpages and our webpage? Okay. So we're strongly encouraging that. In fact, it's one of all the landing sites of our website. So far, it's been one of the most popular, both from, I guess, I don't know if we differentiate between members and non-members, but it's been very popular. And we're actually having a big social media presence ourselves already, and we're gonna be doing a big campaign as well with it. We definitely encourage our members to go and use the resources that we were talking about tonight in the specific ways that Erin and Ilche were talking about. And I do think that we also would love to have opportunities for them to interact with us via the testimonial, via feedback to us as to how we could be more helpful with them individually in their local communities with resources and tools, perhaps through the Practice Operations Committee and perhaps through Eden, the Endoscopic Unit Recognition Program, ASCs. I don't know how many member of them are out there tonight, but there's a lot of various interesting networks of practicing gastrologists throughout the country that are part of the ASC family here. And we'd like them to use our site, find the great information that's all located in one landing page, and to use that in their own practices for sure. Great, thank you, John. Eden, next question, please. So I think we're just about ready for the round robin, Dr. Bakir. Well, actually, I saw another question pop up. Let me, if I could just take a quick moment. Sure, sorry if I didn't catch that. That's okay. Oh, I'm sorry, I think we covered it. I was a little bit behind on that, my apologies. I think we are ready to go the direction you suggested. Okay, who would you like to start your round robin with? Sure, so let's finish up with some pearls. Let's start with Aaron, please. A pearl that you can teach us, or teach our colleagues that you've learned from your work. Yeah, I think the most important thing that I've learned from all this is to just, when your patients come in for a colonoscopy, find out what information they've been given. Because that's really what we're trying to modify with all this is to know what's going on what the conversation that they're having that happened prior to them landing in our endoscopy center because that information is extremely useful. You can use that to guide your plan of attack when it comes to getting the value of colonoscopy out to both patients and providers. Thank you, Aaron. Nancy, a pearl that you learned from working on your project at VOC or any other pearl you've learned? Sure, I'll just say to this project, these take these, they're sort of out of the box tools and use them. They're there, you don't have to go back and create a wheel and go, gee, what are we gonna do? They're right there for you. So take those and promote safety and value of colonoscopy to your patients. And as I say, you or your loved ones could be attached to the other end of the scope. So it's not just your patients, it's a family of all people who get colorectal cancer. Thank you, Nancy. Ilche. I think making sure that the message you provide is consistent and is delivered frequently and in varied means. And so if we're promoting the colonoscopy as the test that prevents colon cancer, we hit that on a variety of ways and we make sure patients understand the differences and the PCPs understand the differences and we don't waver and we continue to, we've been saying it in various permutations for the last two years. And over time, and I think we are noticing a difference in terms of what patients are telling us when they were coming in, having chosen the colonoscopy as their first test. That's one of the things I've noticed when I ask them, so how did you come across the colonoscopy? And they say, well, I was aware of what the colonoscopy can do and some of the limitations of other testing. So however they're getting the message, it's being conveyed. We need to remain tenacious about delivering it in a very consistent and coordinated way. Thank you, Elche. Erica. So I think that being really transparent with the things that are so obvious to us as healthcare providers with our patients, we are very accustomed to good hand hygiening and room turnover and high level disinfect of our scopes. And so we don't always talk about that with our patients, but those are the things that they're concerned with. And so not to be afraid to be transparent and discuss those things with them because it's really important. And they're the things that we take for granted, they're common sense to us. Thank you, Erica. John, we'll finish up with you with the pearls as the co-chair and as I would refer to the brain trust of the VOC. The final pearl on the floor is yours. I guess maybe I'll take two pearls. The first pearl is always in on time. I think that we need to figure out how to translate our passion for preventing cancer into our expertise in being educators. When we're educating our patients, their family members and our preferring doctors, especially in one-on-one is when we're most effective. These tools will help us do that in a very simple way. And I think in a very graphical way and we're gonna use various different formats, but will let us, when an opportunity arises, someone comes in with a positive Cologuard that was actually had three polyps three years ago, educate them and also educate our well-meaning PCPs who really will be grateful for education presented in the right way so that they too can do the best to help prevent cancer in their patients. We gotta be all aligned. We have the skills and now we're hopefully developing the materials to make it easier for us to do that. And I think that ultimately will be the most effective way to promote the value of colonoscopy. Thank you, Jonathan. Thank you, everyone. Before I turn the presentation back to Eden, I wanna thank all of our panelists. I think this was an outstanding discussion. As John said earlier, very practical tips and all very well done. So thank you very much for taking time out of your busy schedules. And thank you to the audience and attendees for taking time out of your busy schedules to spend the night with us. I know that promoting the value of colonoscopy is very important to us. And I think this evening further empowers you in the ongoing dialogues that you have with your referring physicians and patients. Throughout the pandemic, when we had the practice operations discussion forum, we always said that we were in this together. Now that we've moved back to clinical topics, I can't think of a more important clinical topic to say that we are really in this one all together. And when John said earlier, we want feedback, we really do want feedback. I think there's so many ways that you can help and participate. So please reach out to us and tell us what you want on this website and this campaign, and we'll do our best to make it happen. We know that colon cancer is the best test and colonoscopy is the best test to screen for colon cancer. And we certainly wanna promote that and we're very good at it. And with that, I will turn it back to Eden to wrap things up. Well, an excellent job. The kudos are coming in. We're getting many, many thank yous. Thank you for the practical advice and the practical resources. Congratulations to you all on delivering exactly what we hope to tonight in terms of promoting the value of colonoscopy campaign. Before we close out tonight, I will navigate over to the ASGE educational calendar. And I wanted to just highlight the educational opportunities around practice management and quality and safety that are upcoming in the near future. All of our events are always on demand afterwards, just like this webinar tonight. So you can rewatch it or you can refer others to it. We do have a coding webinar series that is quarterly. So we'll have a few more this year, but if you missed this one in February, it is available on demand. So you can still get the complete series. And then up in towards the end of March, we've got the improving quality and safety in your endoscopy unit course. A very popular course that Dr. Cohen actually pioneered and it's been around for 10 plus years. So we have just a couple of events coming your way that you may be interested in. And please let us know if you have any questions about them. In closing, thank you for your participation in this discussion forum on promoting the value of colonoscopy to your referring physicians and patients. This concludes our presentation. We hope this information is useful to you and your practice.

American Society for Gastrointestinal Endoscopy

ASGE

discussion forum

value of colonoscopy

referring physicians

patients

Value of Colonoscopy Campaign

presentations

colon cancer prevention

awareness and understanding

primary care physicians