Patient experiences of MR colonography and colonoscopy: a qualitative study

Abstract

Objectives: The aim of this study was to apply qualitative techniques to assimilate data on patient experience and attitudes during MR colonography (MRC) and colonoscopy (CC). Methods: 18 patients (11 male, 8 female, median age 40.5 years), 10 of whom had known colonic inflammatory bowel disease (IBD) and 8 who were under investigation for suspected colonic neoplasia (non-IBD), underwent MRC and conventional CC. Semistructured interviews were performed to assimilate test experiences and preferences, and themes were extracted using thematic analysis. Results: Thematic analysis identified three main themes: (i) physical experience, (ii) information provision and (iii) overall preference. Patients expressed mixed views about the physical experience of MRC but specifically identified water filling, breath holding and lying still as problematic. Anxiety was expressed regarding potential incontinence. Scanner noise interfered with the understanding of instructions, particularly amongst non-IBD patients. Non-IBD patients expressed greater anxiety over the delay in receiving the MRC report than IBD patients. In general MRI was considered as the more informative and safer investigation. Patients reported more physical discomfort during CC (notably IBD patients) related to air insufflation and colonoscopic manipulation but were more satisfied with the feedback they received. 10 patients (56%) stated an overall preference for MRC and 5 (28%) preferred CC. Reasons for preferences stated by the patients included discomfort, speed of the test, safety, perceived diagnostic ability and the ability to take biopsies. Conclusion: Experiences of MRC and CC are complex and influenced by clinical indication. Individuals place different weightings on the relative importance of test attributes including discomfort, noise, immobility, feedback, safety and fear of incontinence and this defines overall preference. Colonoscopy (CC) remains the reference standard for diagnosing colonic inflammatory bowel disease (IBD) and neoplasia. However there is considerable interest in potentially less invasive radiological alternatives with reduced risk of serious complications. Recent data suggest that MR colonography (MRC) achieves adequate sensitivity for detection and grading of inflammation [1] and is proposed as a safer, less invasive alternative to colonoscopy for monitoring and restaging of IBD.Although diagnostic performance is the major determinant for uptake of any radiological investigation, acceptability to patients is also an important consideration. This is especially relevant in IBD, given the need for repeated colonic examinations over the course of the disease. Patient acceptance is influenced by several factors, including test expectations, comfort, overall satisfaction and diagnostic performance. While it is assumed that patient acceptance of MRC is higher than colonoscopy, this is based on a limited number of studies [2][3][4][5][6][7]. For example, Achiam et al [2] reported that, in a cohort of 64 patients, 71% expressed preferen...

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