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Guardiola-Arévalo A, Granja Navacerrada A, García-Alonso FJ, Bernal Checa P, Piqué Becerra R, Guerra I, Algaba A, de Andrés Esteban E, Bermejo F. Randomized clinical trial evaluating the effect of a visual educational leaflet on the preparation of colonoscopies in hospitalized patients. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:946-952. [PMID: 31755280 DOI: 10.17235/reed.2019.6317/2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND the safety and diagnostic accuracy of colonoscopies depends on the quality of colon cleansing. Several factors have been reported that affect the quality of bowel cleansing, hospitalization being one of them. AIMS the aim of the study was to investigate whether a visual educational leaflet improved the level of cleanliness achieved in hospitalized patients undergoing a colonoscopy and to identify predictors of a poor bowel preparation. METHODS a prospective, single-center, endoscopist-blinded, randomized controlled trial was performed. The intervention group was given a visual educational leaflet and both groups received four liters of polyethylene glycol solution. Demographic data, personal history, reason for admission and indication for colonoscopy, work shift during which the procedure was performed and endoscopy findings were collected. The Boston Bowel Preparation Scale (BBPS) was used to assess the bowel preparation. RESULTS one hundred and thirty-six patients were included in the study; 51.5% were male, with a mean age of 64.3 ± 17.6 years. The educational leaflet did not result in a difference in the total BBPS obtained between the standard group and the intervention group (7 [6-9] vs 6 [5.7-9]; p = 0.17). According to the multivariable analysis, the only factors associated with a poor bowel cleansing were heart disease (OR 3.37 [1.34-8.46]; p = 0.010) and colorectal cancer (OR 3.82 [1.26-11.61]; p = 0.018). CONCLUSION the use of a visual educational leaflet for the preparation of colonoscopies did not provide a significant improvement in hospitalized patients in our health area. Heart disease was identified as the only predictor of poor preparation for colonoscopy.
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Affiliation(s)
| | | | | | - Pilar Bernal Checa
- Department of Gastroenterology, Hospital Universitario de Fuenlabrada, España
| | - Rubén Piqué Becerra
- Department of Gastroenterology, Hospital Universitario de Fuenlabrada, España
| | - Ivan Guerra
- Department of Gastroenterology.IdiPAZ, Hospital Universitario de Fuenlabrada, España
| | - Alicia Algaba
- Department of Gastroenterology. IdiPAZ, Hospital Universitario de Fuenlabrada, España
| | | | - Fernando Bermejo
- Department of Gastroenterology. IdiPAZ, Hospital Universitario de Fuenlabrada, España
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Shafer LA, Walker JR, Waldman C, Yang C, Michaud V, Bernstein CN, Hathout L, Park J, Sisler J, Restall G, Wittmeier K, Singh H. Factors Associated with Anxiety About Colonoscopy: The Preparation, the Procedure, and the Anticipated Findings. Dig Dis Sci 2018; 63:610-618. [PMID: 29332165 DOI: 10.1007/s10620-018-4912-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 01/02/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previous research has assessed anxiety around colonoscopy procedures, but has not considered anxiety related to different aspects related to the colonoscopy process. AIMS Before colonoscopy, we assessed anxiety about: bowel preparation, the procedure, and the anticipated results. We evaluated associations between patient characteristics and anxiety in each area. METHODS An anonymous survey was distributed to patients immediately prior to their outpatient colonoscopy in six hospitals and two ambulatory care centers in Winnipeg, Canada. Anxiety was assessed using a visual analog scale. For each aspect, logistic regression models were used to explore associations between patient characteristics and high anxiety. RESULTS A total of 1316 respondents completed the questions about anxiety (52% female, median age 56 years). Anxiety scores > 70 (high anxiety) were reported by 18% about bowel preparation, 29% about the procedure, and 28% about the procedure results. High anxiety about bowel preparation was associated with female sex, perceived unclear instructions, unfinished laxative, and no previous colonoscopies. High anxiety about the procedure was associated with female sex, no previous colonoscopies, and confusing instructions. High anxiety about the results was associated with symptoms as an indication for colonoscopy and instructions perceived as confusing. CONCLUSIONS Fewer people had high anxiety about preparation than about the procedure and findings of the procedure. There are unique predictors of anxiety about each colonoscopy aspect. Understanding the nuanced differences in aspects of anxiety may help to design strategies to reduce anxiety, leading to improved acceptance of the procedure, compliance with preparation instructions, and less discomfort with the procedure.
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Affiliation(s)
- L A Shafer
- Department of Internal Medicine, Section of Gastroenterology, University of Manitoba, 805-715 McDermot Avenue, Winnipeg, MB, R3E3P4, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada
| | - J R Walker
- IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada.,Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - C Waldman
- Department of Internal Medicine, Section of Gastroenterology, University of Manitoba, 805-715 McDermot Avenue, Winnipeg, MB, R3E3P4, Canada.,Faculty of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - C Yang
- Department of Internal Medicine, Section of Gastroenterology, University of Manitoba, 805-715 McDermot Avenue, Winnipeg, MB, R3E3P4, Canada
| | - V Michaud
- Department of Internal Medicine, Section of Gastroenterology, University of Manitoba, 805-715 McDermot Avenue, Winnipeg, MB, R3E3P4, Canada
| | - C N Bernstein
- Department of Internal Medicine, Section of Gastroenterology, University of Manitoba, 805-715 McDermot Avenue, Winnipeg, MB, R3E3P4, Canada.,IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada
| | - L Hathout
- Department of Internal Medicine, Section of Gastroenterology, University of Manitoba, 805-715 McDermot Avenue, Winnipeg, MB, R3E3P4, Canada
| | - J Park
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada.,Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - J Sisler
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada.,Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - G Restall
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - K Wittmeier
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - H Singh
- Department of Internal Medicine, Section of Gastroenterology, University of Manitoba, 805-715 McDermot Avenue, Winnipeg, MB, R3E3P4, Canada. .,Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada. .,IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada. .,Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada.
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Silvester JA, Kalkat H, Graff LA, Walker JR, Singh H, Duerksen DR. Information seeking and anxiety among colonoscopy-naïve adults: Direct-to-colonoscopy vs traditional consult-first pathways. World J Gastrointest Endosc 2016; 8:701-708. [PMID: 27909550 PMCID: PMC5114459 DOI: 10.4253/wjge.v8.i19.701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/28/2016] [Accepted: 07/22/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate the effects of direct to colonoscopy pathways on information seeking behaviors and anxiety among colonoscopy-naïve patients.
METHODS Colonoscopy-naïve patients at two tertiary care hospitals completed a survey immediately prior to their scheduled outpatient procedure and before receiving sedation. Survey items included clinical pathway (direct or consult), procedure indication (cancer screening or symptom investigation), telephone and written contact from the physician endoscopist office, information sources, and pre-procedure anxiety. Participants reported pre-procedure anxiety using a 10 point scale anchored by “very relaxed” (1) and “very nervous” (10). At least three months following the procedure, patient medical records were reviewed to determine sedative dose, procedure indications and any adverse events. The primary comparison was between the direct and consult pathways. Given the very different implications, a secondary analysis considering the patient-reported indication for the procedure (symptoms or screening). Effects of pathway (direct vs consult) were compared both within and between the screening and symptom subgroups.
RESULTS Of 409 patients who completed the survey, 34% followed a direct pathway. Indications for colonoscopy were similar in each group. The majority of the participants were women (58%), married (61%), and internet users (81%). The most important information source was family physicians (Direct) and specialist physicians (Consult). Use of other information sources, including the internet (20% vs 18%) and Direct family and friends (64% vs 53%), was similar in the Direct and Consult groups, respectively. Only 31% of the 81% who were internet users accessed internet health information. Most sought fundamental information such as what a colonoscopy is or why it is done. Pre-procedure anxiety did not differ between care pathways. Those undergoing colonoscopy for symptoms reported greater anxiety [mean 5.3, 95%CI: 5.0-5.7 (10 point Likert scale)] than those for screening colonoscopy (4.3, 95%CI: 3.9-4.7).
CONCLUSION Procedure indication (cancer screening or symptom investigation) was more closely associated with information seeking behaviors and pre-procedure anxiety than care pathway.
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Comorbid Illness, Bowel Preparation, and Logistical Constraints Are Key Reasons for Outpatient Colonoscopy Nonattendance. Can J Gastroenterol Hepatol 2016; 2016:2179354. [PMID: 27478818 PMCID: PMC4958479 DOI: 10.1155/2016/2179354] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/08/2016] [Accepted: 06/26/2016] [Indexed: 02/08/2023] Open
Abstract
Background. Colonoscopy nonattendance is a challenge for outpatient clinics globally. Absenteeism results in a potential delay in disease diagnosis and loss of hospital resources. This study aims to determine reasons for colonoscopy nonattendance from a Canadian perspective. Design. Demographic data, reasons for nonattendance, and patient suggestions for improving compliance were elicited from 49 out of 144 eligible study participants via telephone questionnaire. The 49 nonattenders were compared to age and sex matched controls for several potential contributing factors. Results. Nonattendance rates were significantly higher in winter months; the OR of nonattendance was 5.2 (95% CI, 1.6 to 17.0, p < 0.001) in winter versus other months. Being married was positively associated with attendance. There was no significant association between nonattendance and any of the other variables examined. The top 3 reasons for nonattendance were being too unwell to attend the procedure, being unable to complete bowel preparation, or experiencing logistical challenges. Conclusions. Colonoscopy attendance rates appear to vary significantly by season and it may be beneficial to book more colonoscopies in the summer or overbook in the winter. Targets for intervention include more tailored teaching sessions, reminders, taxi chits, and developing a hospital specific colonoscopy video regarding procedure and bowel preparation requirements.
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Kao SH, Hsu LL, Hsieh SI, Huang TH. The effects of two educational interventions on knowledge and competence of nurses with regard to conveying gastroscopy-related information to patients. J Adv Nurs 2012; 69:793-804. [PMID: 22709135 DOI: 10.1111/j.1365-2648.2012.06062.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM The study was to compare the effects of two different educational interventions on knowledge and competence of nurses regarding conveying gastroscopy-related information to patients. BACKGROUND Nurses play an important role in helping patients undergo gastroscopy and must be familiar with the procedure to provide related patient education. DESIGN A quasi-experimental study. METHODS This study in 2010 involved a pre-test and two post-tests. The experimental group (n=25) received a multimedia CD-ROM, and the comparator group (n=40) received a pocket booklet. The effects of the two educational interventions were measured using the Knowledge Test Gastroscopy Nursing Instruction Scale, the Self-Evaluation Gastroscopy Nursing Instruction Scale, and the Gastroscopy Nursing Instruction Learning Satisfaction Scale. RESULTS No overall significant difference in knowledge scores between the two groups was found, but subsequent post hoc analysis showed significantly higher scores in the experimental group than in the comparator group at week 6. A significant within-subjects effect of the self-evaluation gastroscopy nursing instruction scores from baseline-week 6 was dependent on the experimental group or the comparator group. There were significant between-subjects effects overall, at week 3 and at week 6. CONCLUSION Both educational interventions improved nurses' knowledge and competence in gastroscopy-related information. However, the CD-ROM-based intervention had long-term effects on knowledge and had short-term and long-term effects on competence.
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Affiliation(s)
- Shu-Hua Kao
- Department of Nursing, Chang Gung Medical Foundation, Chang Gung Memorial Hospital at Taoyuan, Taiwan
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Armstrong D, Barkun A, Bridges R, Carter R, de Gara C, Dube C, Enns R, Hollingworth R, Macintosh D, Borgaonkar M, Forget S, Leontiadis G, Meddings J, Cotton P, Kuipers EJ. Canadian Association of Gastroenterology consensus guidelines on safety and quality indicators in endoscopy. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2012; 26:17-31. [PMID: 22308578 PMCID: PMC3275402 DOI: 10.1155/2012/173739] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Accepted: 10/04/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality, highlight the need for clearly defined, evidence-based processes to support quality improvement in endoscopy. OBJECTIVE To identify processes and indicators of quality and safety relevant to high-quality endoscopy service delivery. METHODS A multidisciplinary group of 35 voting participants developed recommendation statements and performance indicators. Systematic literature searches generated 50 initial statements that were revised iteratively following a modified Delphi approach using a web-based evaluation and voting tool. Statement development and evidence evaluation followed the AGREE (Appraisal of Guidelines, REsearch and Evaluation) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidelines. At the consensus conference, participants voted anonymously on all statements using a 6-point scale. Subsequent web-based voting evaluated recommendations for specific, individual quality indicators, safety indicators and mandatory endoscopy reporting fields. Consensus was defined a priori as agreement by 80% of participants. RESULTS Consensus was reached on 23 recommendation statements addressing the following: ethics (statement 1: agreement 100%), facility standards and policies (statements 2 to 9: 90% to 100%), quality assurance (statements 10 to 13: 94% to 100%), training, education, competency and privileges (statements 14 to 19: 97% to 100%), endoscopy reporting standards (statements 20 and 21: 97% to 100%) and patient perceptions (statements 22 and 23: 100%). Additionally, 18 quality indicators (agreement 83% to 100%), 20 safety indicators (agreement 77% to 100%) and 23 recommended endoscopy-reporting elements (agreement 91% to 100%) were identified. DISCUSSION The consensus process identified a clear need for high-quality clinical and outcomes research to support quality improvement in the delivery of endoscopy services. CONCLUSIONS The guidelines support quality improvement in endoscopy by providing explicit recommendations on systematic monitoring, assessment and modification of endoscopy service delivery to yield benefits for all patients affected by the practice of gastrointestinal endoscopy.
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Affiliation(s)
- David Armstrong
- Division of Gastroenterrology, McMaster University, Hamilton, Ontario, Canada.
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Singh H, Petersen LA, Daci K, Collins C, Khan M, El-Serag HB. Reducing referral delays in colorectal cancer diagnosis: is it about how you ask? Qual Saf Health Care 2010; 19:e27. [PMID: 20584706 DOI: 10.1136/qshc.2009.033712] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Delays in colorectal cancer (CRC) diagnosis related to colonoscopy referrals are not well studied. The authors tested whether certain details of information transmitted through computerised provider order entry (CPOE)-based referrals affected timeliness of diagnostic colonoscopy for patients with newly diagnosed CRC. METHODS The authors studied a 6-year cohort of all newly diagnosed patients with CRC at a large tertiary care Veterans Affairs hospital and its affiliated multispecialty clinics. Referring providers included primary care clinicians, resident trainees and other specialists. From the colonoscopy referral preceding CRC diagnosis, the authors determined request date, type and frequency of diagnostic clues provided (symptoms, signs, test results), notation of urgency, and documented evidence of verbal contact between referring provider and consultant to expedite referral. The authors compared distributions of proportions of diagnostic clues between patients with a lag of >60 and ≤60 day, and examined predictors of lag time. RESULTS Of 367 electronic referrals identified with a median lag of 57 days, 178 (48.5%) had a lag of >60 days. Referrals associated with longer lag times included those with 'positive faecal occult blood test' (92 days, p<0.0001), 'haematochesia' (75 days, p=0.02), 'history of polyps' (221 days, p=0.0006) and when 'screening' (vs specific symptoms) was given as the reason for diagnostic colonoscopy (203 days, p=0.002). Independent predictors of shorter wait times included three diagnostic clues, notation of urgency and documentation of verbal contact. CONCLUSIONS Attention to certain details of diagnostic information provided to consultants through CPOE-based referrals may help reduce delays in CRC diagnosis.
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Affiliation(s)
- Hardeep Singh
- VA Medical Center 152, 2002 Holcombe Blvd, Houston, TX 77030, USA.
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