Factors Associated with Anxiety About Colonoscopy: The Preparation, the Procedure, and the Anticipated Findings

Shafer, Leigh Anne; Walker, John R.; Waldman, Celeste; Yang, Chengyue; Michaud, Valérie; Bernstein, Çharles N.; Hathout, Linda; Park, J.; Sisler, Jeffrey; Restall, Gayle; Wittmeier, Kristy; Singh, Harminder

doi:10.1007/s10620-018-4912-z

Cited by 55 publications

(58 citation statements)

References 45 publications

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“…Past work found colonoscopy patients to be anxious about bowel preparation, the procedure itself and results 28. Our findings develop this further, showing anxiety can be present across the entire journey, starting while patients await appointments, and that this applies to CTC and OGD as well as colonoscopy.…”

Section: Discussionsupporting

confidence: 70%

Patient experience of gastrointestinal endoscopy: informing the development of the Newcastle ENDOPREM™

Neilson

Patterson

Wagner

et al. 2020

Frontline Gastroenterol

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BackgroundMeasuring patient experience is important for evaluating the quality of patient care, identifying aspects requiring improvement and optimising patient outcomes. Patient Reported Experience Measures (PREMs) should, ideally, be patient derived, however no such PREMs for gastrointestinal (GI) endoscopy exist. This study explored the experiences of patients undergoing GI endoscopy and CT colonography (CTC) in order to: identify aspects of care important to them; determine whether the same themes are relevant across investigative modalities; develop the framework for a GI endoscopy PREM.MethodsPatients aged ≥18 years who had undergone oesophagogastroduodenoscopy (OGD), colonoscopy or CTC for symptoms or surveillance (but not within the national bowel cancer screening programme) in one hospital were invited to participate in semi-structured interviews. Recruitment continued until data saturation. Inductive thematic analysis was undertaken.Results35 patients were interviewed (15 OGD, 10 colonoscopy, 10 CTC). Most patients described their experience chronologically, and five ‘procedural stages’ were evident: before attending for the test; preparing for the test; at the hospital, before the test; during the test; after the test. Six themes were identified: anxiety; expectations; choice & control; communication & information; comfort; embarrassment & dignity. These were present for all three procedures but not all procedure stages. Some themes were inter-related (eg, expectations & anxiety; communication & anxiety).ConclusionWe identified six key themes encapsulating patient experience of GI procedures and these themes were evident for all procedures and across multiple procedure stages. These findings will be used to inform the development of the Newcastle ENDOPREM™.

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Section: Discussionsupporting

confidence: 70%

Patient experience of gastrointestinal endoscopy: informing the development of the Newcastle ENDOPREM™

Neilson

Patterson

Wagner

et al. 2020

Frontline Gastroenterol

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“…Nonattendance is a common problem at endoscopy units and a rate of 10% is to be expected [29,30] and adds to the question of optimal use of diagnostic resources. It is a reminder that, even though colonoscopy is unsurpassed for combined diagnostic and interventional purposes, for patients it is also associated with inconvenience, anxiety and pain [31].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of a quantitative faecal immunochemical test vs. symptoms suspected for colorectal cancer in patients referred for colonoscopy

Tsapournas

Hellström

Cao

et al. 2020

Scandinavian Journal of Gastroenterology

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Objective: Determine diagnostic accuracy of a quantitative faecal immunochemical haemoglobin test (QuikRead go V R FIT, Orion Diagnostica Oy) in symptomatic patients referred for colonoscopy, at various cutoffs and for one or two tests. Methods: Patients referred to four endoscopy units in mid-Sweden between 2013 and 2017 provided information on lower abdominal symptoms and faecal samples from two separate days prior to colonoscopy. Results: In all, 5.4% (13/242) patients had colorectal cancer (CRC). For one FIT at cutoff 10 mg Hb/g faeces, sensitivity for CRC was 92% (95% CI 78-100%) and specificity 77% (95% CI 72-83%); equal to 74%; 95% CI 68-80 (178/242) colonoscopies potentially avoidable and one CRC missed. Based on the maximal outcome of two FITs, sensitivity was 100%, specificity 71% (66-77%) and 68%; 95% CI 62-74 (160/237) colonoscopies potentially avoidable. Among 17% (42/242) patients with one FIT of >200 mg Hb/g faeces, 85% (11/13) had CRC. Positive predictive values of FIT varied 16.9-26.2% depending on cutoff and one or two FITs, whereas NPVs were 99% and above in all scenarios. In 60 patients reporting rectal bleeding, one FIT at cutoff 10 mg Hb/g discriminated well between CRC and other conditions (p ¼ .001). In regression models, FIT was more important than age, sex and all symptoms. Conclusion: One or two FITs in symptomatic patients referred for colonoscopy imply powerful risk stratification abilities for CRC, even among patients reporting rectal bleeding. Larger studies in various settings will clarify how to make the best use of this opportunity.

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“…This phase of the study did not directly obtain the perspectives of patients. However, in other phases we surveyed patients about their experiences with colonoscopy procedures [ 29 ] and completed individual patient interviews (manuscript in preparation). Focus group methodology uses the blended voice of the entire group so dissenting voices may not have shared opinions because participants may have been reluctant to disagree with their colleagues.…”

Section: Discussionmentioning

confidence: 99%

Perspectives of primary care providers and endoscopists about current practices, facilitators and barriers for preparation and follow-up of colonoscopy procedures: a qualitative study

Restall

Walker

Waldman

et al. 2018

BMC Health Serv Res

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BackgroundColonoscopy has become a common medical procedure due to increased use of colonoscopy for evaluation of symptoms, colorectal cancer screening and surveillance of people with higher risks of developing colorectal cancer. Timely access to colonoscopy is essential for diagnosis of colorectal cancer, as well as diagnosis and management of inflammatory bowel disease and gastrointestinal symptoms such as diarrhea. The purpose of this study was to obtain the perspectives of primary care providers and endoscopists about current practices, barriers and facilitators to following recommended practice for preparation and follow-up after colonoscopy. We also aimed to obtain recommendations for approaches to improve the process.MethodsSix focus groups (two with gastroenterologists, two with surgeons who perform colonoscopies and two with primary care providers) were held between October 2015 and January 2016. Analysis was performed using inductive qualitative approaches.ResultsVariations and challenges in communication for continuity of care and understanding the distribution of responsibility were identified, as were perceived benefits and challenges of a central intake system for colonoscopies. Recommendations were made to improve processes including strengthening communication and information sharing. A comprehensive quality improvement plan would facilitate implementation of recommendations.ConclusionsFindings emphasize the need for improved patient-focused information resources for each step of the colonoscopy process and improved communication among practitioners. The findings apply to other services requiring collaboration among patients, primary care providers, and medical specialists.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3567-y) contains supplementary material, which is available to authorized users.

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Factors Associated with Anxiety About Colonoscopy: The Preparation, the Procedure, and the Anticipated Findings

Cited by 55 publications

References 45 publications

Patient experience of gastrointestinal endoscopy: informing the development of the Newcastle ENDOPREM™

Patient experience of gastrointestinal endoscopy: informing the development of the Newcastle ENDOPREM™

Diagnostic accuracy of a quantitative faecal immunochemical test vs. symptoms suspected for colorectal cancer in patients referred for colonoscopy

Perspectives of primary care providers and endoscopists about current practices, facilitators and barriers for preparation and follow-up of colonoscopy procedures: a qualitative study

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