Measuring the observer (Hawthorne) effect on adenoma detection rates

Mahsa Taghiakbari; Diana Elena Coman; Mark Takla; Alan Barkun; Mickael Bouin; Simon Bouchard; Eric Deslandres; Sacha Sidani; Daniel von Renteln

doi:10.1055/a-2131-4797

Measuring the observer (Hawthorne) effect on adenoma detection rates

Endosc Int Open. 2023 Oct 6;11(9):E908-E919. doi: 10.1055/a-2131-4797. eCollection 2023 Sep.

Authors

Mahsa Taghiakbari¹, Diana Elena Coman², Mark Takla³, Alan Barkun¹, Mickael Bouin¹, Simon Bouchard^{4

1}, Eric Deslandres^{4

1}, Sacha Sidani^{4

1}, Daniel von Renteln¹

Affiliations

¹ Gastroenterology, Centre Hospitialier de l'Université de Montréal (CHUM), Montreal, Canada.
² Internal Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada.
³ Faculty of Medicine, University of Montreal Hospital Centre, Montreal, Canada.
⁴ Gastroenterology, Centre de Recherche de l'Université de Montréal (CHUM), Montreal, Canada.

Abstract

Background and study aims An independent observer can improve procedural quality. We evaluated the impact of the observer (Hawthorne effect) on important quality metrics during colonoscopies. Patients and Methods In a single-center comparative study, consecutive patients undergoing routine screening or diagnostic colonoscopy were prospectively enrolled. In the index group, all procedural steps and quality metrics were observed and documented, and the procedure was video recorded by an independent research assistant. In the reference group, colonoscopies were performed without independent observation. Colonoscopy quality metrics such as polyp, adenoma, serrated lesions, and advanced adenoma detection rates (PDR, ADR, SLDR, AADR) were compared. The probabilities of increased quality metrics were evaluated through regression analyses weighted by the inversed probability of observation during the procedure. Results We included 327 index individuals and 360 referents in the final analyses. The index group had significantly higher PDRs (62.4% vs. 53.1%, P =0.02) and ADRs (39.4% vs. 28.3%, P =0.002) compared with the reference group. The SLDR and AADR were not significantly increased. After adjusting for potential confounders, the ADR and SLDR were 50% (relative risk [RR] 1.51; 95%, CI 1.05-2.17) and more than twofold (RR 2.17; 95%, CI 1.05-4.47) more likely to be higher in the index group than in the reference group. Conclusions The presence of an independent observer documenting colonoscopy quality metrics and video recording the colonoscopy resulted in a significant increase in ADR and other quality metrics. The Hawthorne effect should be considered an alternative strategy to advanced devices to improve colonoscopy quality in practice.

Keywords: CRC screening; Colorectal cancer; Endoscopic resection (polypectomy, ESD, EMRc, ...); Endoscopy Lower GI Tract; Polyps / adenomas / ....

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