Case Control Study
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2014; 20(48): 18360-18366
Published online Dec 28, 2014. doi: 10.3748/wjg.v20.i48.18360
Perceived risk as a barrier to appropriate diagnosis of irritable bowel syndrome
Eunmi Ahn, Ki Young Son, Dong Wook Shin, Min Kyu Han, Hyejin Lee, Ah Reum An, Eun Ho Kim, BeLong Cho
Eunmi Ahn, Ki Young Son, Dong Wook Shin, Min Kyu Han, Hyejin Lee, Ah Reum An, Eun Ho Kim, BeLong Cho, Department of Family Medicine, Seoul National University Hospital, Seoul 110-744, South Korea
Ki Young Son, Dong Wook Shin, BeLong Cho, Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul 110-744, South Korea
Author contributions: Son KY, Shin DW and Cho B provided the study concept, supervised the study, and contributed critical appraisal of the manuscript; Ahn E, Han MK, Lee H, An AR and Kim EH performed research; Ahn E and Kim EH performed the statistical analysis and interpretation of data; Ahn E, Son KY and Han MK wrote the manuscript; all authors approved the final manuscript.
Supported by Korea Centers for Disease Control and Prevention, No. 800-20120075
Correspondence to: BeLong Cho, MD, PhD, Professor of Family Medicine, Department of Family Medicine, Seoul National University Hospital, 101 Daehak ro, Jongno gu, Seoul 110-744, South Korea. belong@snu.ac.kr
Telephone: +82-2-20722195 Fax: +82-2-7663276
Received: April 11, 2014
Revised: June 16, 2014
Accepted: July 11, 2014
Published online: December 28, 2014
Processing time: 269 Days and 22.9 Hours
Abstract

AIM: To evaluate perceived risk, diagnostic testing, and acceptance of a diagnosis of irritable bowel syndrome (IBS) among the Korean laypersons.

METHODS: We designed a conceptual framework to evaluate the health-seeking behavior of subjects based on a knowledge, attitude, and practice model. We developed a vignette-based questionnaire about IBS based on a literature review and focused group interviews. The vignette described a 40-year-old woman who meets the Rome III criteria for IBS without red-flag signs. It was followed by questions about demographic characteristics, health behaviors, IBS symptoms, risk perception, perceived need for diagnostic tests, and acceptance of a positive diagnosis of IBS. We planned a nationwide survey targeting laypersons without IBS and between the ages of 20 and 69 years. Survey participants were selected by quota sampling stratified by gender, age, and nationwide location. A multivariate logistic model was constructed based on literature reviews, univariate analysis, and a stepwise selection method to investigate correlations between the perceived risk, need for diagnostic tests, and acceptance of a positive diagnosis.

RESULTS: Of 2354 eligible households, 1000 subjects completed the survey and 983 subjects were analyzed, excluding those who met symptom criteria for IBS. After reading the IBS vignette, the majority of subjects (86.8%) responded that the patient was at increased risk of severe disease. The most frequent concern was colon cancer (59.8%), followed by surgical condition (51.5%). Most subjects responded the patient needs diagnostic tests (97.2%). Colonoscopy was the most commonly required test (79.5%). Less than half of the respondents requested a stool examination (45.0%), blood test (40.7%), abdominal ultrasound (36.0%), or computed tomography (20.2%). The subjects who felt increased risk were more likely to see a need for colonoscopy [adjusted odds ratio (aOR) = 2.10, 95%CI: 1.38-3.18]. When asked about the positive diagnosis, the most frequent response was that “the patient would not be reassured” (65.7%). The increased risk perception group was less likely to be reassured by a positive diagnosis of IBS, compared to the other respondents (aOR = 0.52, 95%CI: 0.34-0.78).

CONCLUSION: For IBS diagnosis, increased risk perception is a possible barrier to the appropriate use of diagnostic tests and to the patient’s acceptance of a positive diagnosis.

Keywords: Diagnostic testing; Patient attitude; Positive diagnosis; Functional gastrointestinal disease; Irritable bowel syndrome

Core tip: To our knowledge, this is the first study to evaluate the acceptance of laypersons (as potential patients or lay consultants) with a positive diagnosis of irritable bowel syndrome (IBS). The majority of respondents showed a high perceived need for diagnostic testing (97.2%), especially colonoscopy (79.5%), and most of them were reluctant to accept a positive diagnosis of IBS (65.7%). In addition, the increased risk perception group was less likely to be reassured (adjusted odds ratio = 0.52, 95%CI: 0.34-0.78). Therefore, to help patients accept an appropriate diagnosis of IBS, the health care system must manage the perceived risk of patients.