Acceptability to patients of screening disposable transnasal endoscopy: qualitative interview analysis

Abstract

ObjectivesScreening in selected high risk populations for Barrett’s oesophagus (BO) and oesophageal varices (OVs) has been proposed, but there are obstacles with conventional oesophagogastroduodenoscopy (C-OGD), including patient acceptability. Portable and disposable office-based transnasal endoscopy (TNE) is a feasible and accurate alternative to C-OGD that may have use in primary and secondary care. This article outlines a qualitative analysis of patient experiences of TNE and C-OGD in order to gain an insight into an acceptable delivery of an endoscopic screening service.DesignPurposeful sampling identified 23 participants who then underwent semi-structured interviews to determine their experiences of both procedures. Thematic analysis was conducted to derive meaning from their lived experiences.SettingA secondary care endoscopy unit, clinic room and interview room.ParticipantsPatients referred for BO or OV surveillance and for endoscopy to investigate dyspepsia underwent unsedated TNE using the EG Scan II device followed by C-OGD with or without sedation (patient choice), as part of a clinical trial.ResultsThe themes that arose from our analysis were: inclusivity in one’s own healthcare, comfort level and convenience, validity of the procedure and application to a screening population and a sense of altruism and reciprocity. Positive aspects of TNE included participant empowerment, reduced discomfort and avoidance of conscious sedation. Participants felt that if TNE screening was of proven efficacy it would be welcomed, though views on use in a community setting were mixed.ConclusionsMost patients preferred TNE to unsedated C-OGD and the reasons they gave featured strongly in the emerging themes. Preferences between TNE and sedated C-OGD were more subtle, with equivalent comfort scores but merits and drawbacks of both being discussed. This information identifies opportunities and challenges in establishing an endoscopic screening service. Trial registration number ISRCTNregistry identifier: 70595405; Pre-results.

Public Preferences and Predicted Uptake for Esophageal Cancer Screening Strategies: A Labeled Discrete Choice Experiment

“…Qualitative (survey) studies have determined the extent to which patients prefer minimally invasive screening tests compared with upper endoscopy. Nonsurprisingly, consistent with our findings, these studies showed that minimally invasive screening methods were preferred over upper endoscopy ( 28 – 30 ). Quantitative data on the acceptability of novel screening modalities have been obtained in EAC screening studies.…”

Public acceptance and uptake of oesophageal adenocarcinoma screening strategies: A mixed-methods systematic review

“…(2017), UK 28 Semistructured interviews, focus groups Community sample 50–69 y, GORD symptoms/PPI records* 33 Cytosponge-TFF3 Hypothetical Yes Acceptability Fair McGoran et al. (2019), UK 30 Semistructured interviews Secondary care Referral for dyspepsia 4 TNE, EGD Experienced Yes Expectations and experiences Good Tan et al. (2019), UK 31 Cross-sectional analysis Facebook community NR NR Cytosponge-TFF3 Hypothetical Yes Public perspective and barriers towards uptake Medium Mixed methods Peters et al.…”

“…The included studies were published between 2004 and 2020 and were performed in the United States (US) ( n = 9), 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 United Kingdom (UK) ( n = 5), 27 , 28 , 29 , 30 , 31 the Netherlands ( n = 3), 32 , 33 , 34 Israel ( n = 1), 35 and Japan ( n = 1). 36 Study participants experienced a real-life screening procedure ( n = 14), 18 , 19 , 20 , 21 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 32 , 35 , 36 or completed a questionnaire or interview on their intent to participate in OAC screening ( n = 5). 22 , 28 , 31 , 33 , 34 Study designs included cohort studies ( n = 7), 21 , 23 , 25 , 26 , 29 , 35 , 36 a case-control study ( n = 1), 32 randomised controlled trials (RCTs) ( n = 5), 18 , 19 , 20 , 24 , 27 qualitative studies ( n = 3), 28 , 30 , 31 DC...…”

“… 36 Study participants experienced a real-life screening procedure ( n = 14), 18 , 19 , 20 , 21 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 32 , 35 , 36 or completed a questionnaire or interview on their intent to participate in OAC screening ( n = 5). 22 , 28 , 31 , 33 , 34 Study designs included cohort studies ( n = 7), 21 , 23 , 25 , 26 , 29 , 35 , 36 a case-control study ( n = 1), 32 randomised controlled trials (RCTs) ( n = 5), 18 , 19 , 20 , 24 , 27 qualitative studies ( n = 3), 28 , 30 , 31 DCEs ( n = 2), 33 , 34 and a survey ( n = 1). 22 The DCE design is a form of trade-off analysis that is increasingly used in healthcare research.…”

“…Ten studies assessed conventional upper endoscopy, which is currently the gold standard for both screening and surveillance of BO. 18 , 20 , 22 , 24 , 26 , 30 , 32 , 33 , 35 , 36 Several studies investigated less-invasive endoscopic alternatives: ultrathin transnasal endoscopy ( n = 9), 18 , 19 , 20 , 22 , 23 , 24 , 30 , 33 , 36 ultrathin oral endoscopy ( n = 2), 25 , 36 and oesophageal capsule endoscopy, which avoids insertion of an endoscope ( n = 5). 19 , 20 , 22 , 26 , 35 One study assessed tethered capsule microendoscopy, in this case the oesophageal capsule implements optical coherence tomography to collect microscopic images of the oesophagus.…”