Experiences of Patients Undergoing Bowel Preparation and Colonoscopy: A Qualitative Longitudinal Study

Abstract

Introduction: Colonoscopy remains the reference standard for diagnosing and monitoring colorectal cancer and for diagnosis and surveillance of inflammatory bowel disease. However, there is a limited knowledge of the patients' needs when undergoing colonoscopy and the challenges within in order to reduce the number of cancelled colonoscopies. The purpose of the study was to explore the experiences of undergoing bowel preparation and colonoscopy. Methods: The study was designed as a qualitative longitudinal interview study with an inductive research approach. Patients were considered for inclusion consecutively and selected based on the following criteria of variation: way of referral for colonoscopy (outpatient or screening), age and gender. The interviews were analyzed using qualitative content analysis, and results reported according to COREQ guidelines. Results: Based on the findings, three categories emerged: To weigh up participation, A greater challenge than expected, and Not so challenging after all. Throughout these categories, the experience of uncertainty was reported. Discussion: The process of undergoing bowel preparation and colonoscopy was influenced by uncertainty due to insufficient information. There is a need to strengthen the patientcentered care by adjusting the information to patient's needs to better support them in decision-making for participation, to better prepare them for the bowel preparation and to better prepare them for the procedure. In addition, it is vital that patients are provided with results of the colonoscopy that correspond to the timeframe specified in written information.

Patient-Reported Experience Measures for Colonoscopy: A Systematic Review and Meta-Ethnography

“…The studies included participants who were undergoing a screening colonoscopy [34,35,41,42,44], or where the participants' indication for the colonoscopy was either colonic inflammatory bowel disease or suspected colonic neoplasia [33,36,37]. Two studies included patients within colorectal cancer screening as well as patients with other clinical indications [32,40], one study explicitly stated that the participants had no suspected cancer [43], and two studies had no reporting indication [38,39]. Seven studies clearly stated that some participants had undergone more than one colonoscopy [33,34,[37][38][39]41,44].…”

“…Seven studies clearly stated that some participants had undergone more than one colonoscopy [33,34,[37][38][39]41,44]. The data were collected after the colonoscopy procedure, using either individual interviews [32,33,[35][36][37][38][39][40]42,43] or focus group interviews [34,41]. One study used both individual and focus group interviews [44].…”

“…One study used both individual and focus group interviews [44]. All but two [40,44] were single-centre studies and conducted in Australia (n = 2), Canada (n = 1), Denmark (n = 3), Sweden (n = 2), the United Kingdom (n = 3), and the United States (n = 2). Three studies compared the patients' experiences of colonoscopy with other alternative examinations of the colon [33,42,43].…”

“…All thirteen studies presented findings regarding different aspects of Discomfort, either before, during, or after the procedure [32][33][34][35][36][37][38][39][40][41][42][43][44].…”

“…In particular, patients with diabetes experienced the bowel prepara-tion as difficult due to their diet restrictions and fluctuations in their plasma glucose levels [34,41]. Other patients, too, were concerned about the aspect of dietary restrictions, which were experienced as overwhelming due to the planning and preparation of meals that often deviated from their usual routine [40]. Overall, the bowel preparation was experienced as unpleasant [32,[35][36][37][38]44] and patients felt nervous when they were facing the intake of the large fluid volume [34].…”