Influence of coping style and precolonoscopy information on pain and anxiety of colonoscopy

Randomized controlled trial of effects of a familiarization video and patient-controlled Entonox inhalation on patient stress levels and clinical efficacy of flexible sigmoidoscopy without analgesia or sedation for investigation of fresh rectal bleeding

BACKGROUND AND AIM

Flexible sigmoidoscopy (FS) without analgesia or sedation can be unpleasant for patients, resulting in unsatisfactory examinations. Prior familiarization videos (FVs) and intra-procedural Entonox inhalation have shown inconsistent effects. This study investigated their effects on undesirable participant factors (anxiety, stress, discomfort, pain, satisfaction, later unpleasant recall of procedure, and vasovagal reactions) and clinical effectiveness (extent of bowel seen, lesions detected, and procedural/recovery times).

METHODS

This cluster-randomized single-center study evaluated 138 participants undergoing FS. There were 46 controls, 49 given access to FV, and 43 access to both FV and self-administered Entonox. Participant factors were measured by self-administered questionnaires, independent nurse assessments, and heart rate variability (HRV) metrics.

RESULTS

Questionnaires showed that the FV group was slightly more tense and upset before FS, but knowledge of Entonox availability reduced anxiety. Nonlinear HRV metrics confirmed reduced intra-procedural stress response in the FV/Entonox group compared with controls and FV alone (P < 0.05). Entonox availability allowed more bowel to be examined (P < 0.001) but increased procedure time (P < 0.05), while FV alone had no effect. FV/Entonox participants reported 1 month after FS less discomfort during the procedure. Other comparisons showed no significant differences between treatment groups, although one HRV metric showed some potential to predict vasovagal reactions.

CONCLUSIONS

Entonox availability significantly improved clinical effectiveness and caused a slight reduction in undesirable participant factors. The FV alone did not reduce undesirable participant factors or improve clinical effectiveness. Nonlinear HRV metrics recorded effects in agreement with stress reduction and may be useful for prediction of vasovagal events in future studies.

Preparing patients according to their individual coping style improves patient experience of magnetic resonance imaging

MRI-related anxiety is present in 30% of patients and may evoke motion artifacts/failed scans, which impair clinical efficiency. It is unclear how patient anxiety can be countered most effectively. Habitual preferences for coping with stressful situations by focusing or distracting one’s attention thereof (coping style) may play a key role in this context. This study aimed to compare the effectiveness of two patient-preparation videos with informational vs. relaxational content and to determine whether the fit between content and coping style affects effectivity. The sample consisted of 142 patients (M = 48.31 ± 15.81 years). Key outcomes were anxiety, and cortisol as a physiological stress marker. When not considering coping style, neither intervention improved the patients’ reaction; only patient preparation that matched the patients’ coping style was associated with an earlier reduction of anxiety. This suggests that considering individual preferences for patient preparation may be more effective than a one-size-fits-all approach.

Alleviating Pregastroscopy Anxiety Using Mobile Social Media Application

Aim

The research aimed to study the effect of using WeChat (a mobile social media application) on pregastroscopy anxiety and the cooperation of patients with different coping styles.

Methods

In order to decrease patients' pregastroscopy anxiety and improve the tolerance of unsedated gastroscopy, WeChat, a widely used mobile social media application, was applied to provide information prior to their endoscopic procedure. Two hundred and thirty patients who underwent initial unsedated gastroscopy in a large teaching hospital in China were classified into two groups based on their coping style: information seekers or information avoiders, using the Information Subscale of the Krantz Health Opinion Survey (KHOS-I). Each of the two groups was prospectively randomly assigned to either receiving the brochure information or conjunctive interactive WeChat-delivered information of gastroscopy. To measure the level of state anxiety, the State Anxiety Scale of Spielberg's State-Trait Anxiety Inventory questionnaire was used. State anxiety, blood pressure and heart rate were measured at enrollment, upon arrival, and before gastroscopy.

Results

Information seekers and avoiders who received information from the brochure and the WeChat platform experienced significantly less state anxiety upon arrival and before gastroscopy. Furthermore, information seekers who received information from the conjunctive WeChat platform had lower frequency of retching, lower scores of nausea and bloating, and better tolerance. Information avoiders who received information from the conjunctive WeChat platform had lower frequency of retching, lower scores of discomfort while swallowing the scope and nausea, and better tolerance. However, we found the percentage of information seekers who preferred no WeChat-delivered pregastroscopy information is greater than WeChat-delivered information at the initial questionnaire. No significant difference was found in blood pressure or heart rate upon arrival and before gastroscopy.

Conclusions

Although people preferred no WeChat-delivered pregastroscopy information, the provision of gastroscopy information through a mobile social media application, such as WeChat, could significantly reduce patients' pregastroscopy anxiety, lower the frequency of retching, reduce the scores of nausea and bloating, and improve tolerance for information seekers. In addition, it could lower the frequency of retching, reduce the scores of discomfort while swallowing the scope and its concurrent nausea, and improve tolerance for information avoiders.

Improving Colonoscopy Bowel Preparation and Reducing Patient Anxiety Through Recently Developed Online Information Resource: A Cross-sectional Study

Introduction

Invasive medical procedures such as colonoscopies can cause psychological distress and anxiety. Mycolonoscopy.ca is a multilanguage website that provides online written and video information (individual items reported in prior publications to be highly rated by patients) regarding preparation and what to expect before, during, and after colonoscopy. Information about how to access the website is included with all colonoscopy appointment materials in Winnipeg, Manitoba. We evaluated the use of mycolonoscopy.ca among patients undergoing colonoscopy and examined the association between visitation to the website and patient outcomes.

Methods

A paper-based survey was distributed to patients attending their colonoscopy appointments between 11/2019 and 3/2020. Logistic regression analyses were performed to determine the factors associated with website visitation, procedural worry, and bowel preparation scores.

Results

Five hundred and ninety-three surveys were distributed, of which 506 were completed. 17.4% of participants had visited the website before their colonoscopy. Visitors to mycolonoscopy.ca were more likely to consume a split-dose bowel preparation (63.9%) compared with non-visitors (52.5%) (P = 0.006). 31.3% of website visitors were very/extremely worried about their colonoscopy compared with 17.9% of non-visitors. 76.6% of individuals agreed/strongly agreed that visiting the website helped them prepare for their colonoscopy and 69.7% who visited the website agreed/strongly agreed that it helped to reduce their stress/anxiety for the procedure. In multivariable analyses, visitation to website was associated with higher adequate bowel preparation (OR:10.55; 95% CI:1.35 to 82.4).

Conclusion

Use of an informative online platform such as mycolonoscopy.ca can help to improve patient education before colonoscopy, reduce worry surrounding the procedure, and improve bowel preparation.

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

Patient experience is defined as a major quality indicator that should be routinely measured during and after a colonoscopy, according to current ESGE guidelines. There is no standard approach measuring patient experience after the procedure and the comparative performance of the different colonoscopy-specific patient-reported experience measures (PREMs) is unclear. Therefore, the aim was to develop a conceptual model describing how patients experience a colonoscopy, and to compare the model against colonoscopy-specific PREMs. A systematic search for qualitative research published up to December 2021 in PubMed, Cochrane, CINAHL, and PsycINFO was conducted. After screening and quality assessment, data from 13 studies were synthesised using meta-ethnography. Similarities and differences between the model and colonoscopy-specific PREMs were identified. A model consisting of five concepts describes how patients experience undergoing a colonoscopy: health motivation, discomfort, information, a caring relationship, and understanding. These concepts were compared with existing PREMs and the result shows that there is agreement between the model and existing PREMs for colonoscopy in some parts, while partial agreement or no agreement is present in others. These findings suggest that new PREMs for colonoscopy should be developed, since none of the existing colonoscopy-specific PREMs fully cover patients' experiences.

Dealing with Anxious Patients: An Integrative Review of the Literature on Nonpharmaceutical Interventions to Reduce Anxiety in Patients Undergoing Medical or Dental Procedures

Objectives: A previous systematic literature review (SLR) evaluated 501 experiments on reducing patient anxiety across medical and dental environments. This integrative review examines those interventions and explores possible mechanisms leading to relative success or failure within those environments, in the interest of interprofessional education and communication. Methods: Reviewers evaluated 501 experiments testing interventions for reducing patient anxiety in a variety of medical and dental health care settings. Methodology for the SLR, largely following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, is briefly reviewed. Results: A total of 501 experiments (from 408 articles) met review criteria. One hundred and forty-three Music experiments were included, and Music interventions were largely effective, except in the case of colonoscopy. Education is the only intervention that occasionally (5 times of 130 experiments) raised patient anxiety in the face of a procedure; the discussion focuses on the wisdom of assessing patient need for information. Thirty-seven Cognitive Behavioral Therapy (CBT) experiments of various types are included, with a success rate of 89%, with a particularly high rate of success (12 of 12 experiments) in dentistry. Massage has a success rate that is similar to that of CBT, but Massage has been tested in far fewer specialty areas. Relaxation has been tested in every specialty area, except mechanical ventilation, with promising results. Acupuncture and Acupressure have not been widely tested, but their effectiveness rate is 100% when it comes to reducing patient anxiety in various procedural settings. Similarly, experiments show Hypnosis to be successful in 90% of trials. In contrast, Distraction was successful in only 40% of the experiments summarized, although it was more effective in dentistry. A variety of Nature-based Interventions (Aromatherapy, Nature Sounds, and Visual Stimuli) were highly successful across a variety of settings. Discussion: Possible mechanisms are discussed, along with commentary on feasibility. Limitations include publication bias, small sample sizes, and the lack of placebo controls. Future areas of research are pointed out.

Body image, sexual activity, and side effects of treatments across the first year after surgery in women facing breast cancer: The influence of attachment insecurity

Objectives: The aim of this study was to assess, across the first year after surgery, the influence of attachment insecurity, that is, avoidant and anxious tendencies, on body image, sexual activity, and side effects of treatments in women diagnosed with breast cancer.Design: A total of 110 women with non-metastatic breast cancer were surveyed 2 weeks (T1), 3 months (T2), and 12 months (T3) after surgery.Methods: Self-reported questionnaires were used to assess attachment tendencies (avoidance and anxiety), medical data (cancer stage, oncological treatment), sociodemographic data (age, socioeconomic level, relational status), and the three outcomes.Results: Generalized linear modeling showed that (1) having more avoidant and anxious attachment tendencies predicted a more negative body image, as did being younger and having undergone a mastectomy; (2) having more avoidant attachment tendencies predicted being sexually inactive, as did having undergone neoadjuvant chemotherapy or adjuvant hormonal therapy, whereas being younger and in a committed relationship predicted being sexually active; and (3) attachment tendencies did not predict the intensity of side effects, whereas a higher cancer stage and being at the beginning of treatment predicted more side effects.Conclusions: Women with avoidant and anxious attachment tendencies may be especially vulnerable to the consequences of oncological treatment, in particular regarding body image and sexual activity.

Creation of a score to predict risk of high conscious sedation requirements in patients undergoing endoscopy

BACKGROUND AND AIMS

The administration of intravenous conscious sedation to patients undergoing GI endoscopy carries a risk of cardiopulmonary adverse events. Our study aim was to create a score that stratifies the risk of occurrence of either high-dose conscious sedation requirements or a failed procedure.

METHODS

Patients receiving endoscopy via endoscopist-directed conscious sedation were included. The primary outcome was occurrence of sedation failure, which was defined as one of the following: (1) high-dose sedation, (2) the need for benzodiazepine/narcotic reversal agents, (3) nurse-documented poor patient tolerance to the procedure, or (4) aborted procedure. High-dose sedation was defined as >10 mg of midazolam and/or >200 μg of fentanyl or the meperidine equivalent. Patients with sedation failure (n = 488) were matched to controls (n = 976) without a sedation failure by endoscopist and endoscopy date.

RESULTS

Significant associations with sedation failure were identified for age, sex, nonclonazepam benzodiazepine use, opioid use, and procedure type (EGD, colonoscopy, or both). Based on these 5 variables, we created the high conscious sedation requirements (HCSR) score, which predicted the risk of sedation failure with an area under the curve of 0.70. Compared with the patients with a risk score of 0, risk of a sedation failure was highest for patients with a score ≥3.5 (odds ratio, 17.31; P = 2 × 10^-14). Estimated area under the curve of the HCSR score was 0.68 (95% confidence interval, 0.63-0.72) in a validation series of 250 cases and 250 controls.

CONCLUSIONS

The HCSR risk score, based on 5 key patient and procedure characteristics, can function as a useful tool for physicians when discussing sedation options with patients before endoscopy.

Anxiety Associated with Colonoscopy and Flexible Sigmoidoscopy: A Systematic Review

OBJECTIVES

Addressing procedure-related anxiety should improve adherence to colorectal cancer screening programs and diagnostic colonoscopy. We performed a systematic review to assess anxiety among individuals undergoing colonoscopy or flexible sigmoidoscopy (FS).

METHODS

We searched multiple electronic databases for studies evaluating anxiety associated with colonoscopy or FS published from 2005 to 2017. Two reviewers independently identified studies, extracted data, and assessed study quality. The main outcomes were the magnitude of pre-procedure anxiety, types of concerns, predictors of anxiety, and effectiveness of anxiety-lowering interventions in individuals undergoing lower endoscopy. The protocol was prospectively registered in PROSPERO.

RESULTS

Fifty-eight studies (24,490 patients) met the inclusion criteria. Patients undergoing colonoscopy had a higher mean level of anxiety than that previously reported in the general population, with some studies reporting more than 50% of patients having moderate-to-severe anxiety. Areas of anxiety-related concern included bowel preparation, difficulties with the procedure (embarrassment, pain, possible complications, and sedation), and concerns about diagnosis; including fear of being diagnosed with cancer. Female gender, higher baseline anxiety, functional abdominal pain, lower education, and lower income were associated with greater anxiety prior to colonoscopy. Providing higher-quality information before colonoscopy, particularly with a video, shows promise as a way of reducing pre-procedure anxiety but the studies to date are of low quality.

CONCLUSIONS

A large proportion of patients undergoing colonoscopy report anxiety before the procedure. Improvement in pre-procedure information delivery and evaluation of approaches to reduce anxiety is required, especially for those with predictors of pre-procedure anxiety.

Effect of Information of Patients' Coping Style on Pregastroscopy Anxiety

Examination of the relationship between patients' coping style, pregastroscopy information, and anxiety associated with gastroscopy in China was the aim of this study. A pretest, post-test, nonrandom assignment study with a two by two design was conducted. One hundred forty-five patients who underwent initial gastroscopy without sedation were classified into 2 groups on the basis of the coping style: information seekers or information avoiders using the Information Subscale of the Krantz Health Opinion Survey (KHOS-I). All participants were given standardized procedural information about gastroscopy as routine care. Half of each group was assigned to receive additional sensory information describing what sensation they would experience and how to cooperate to alleviate the discomfort. State anxiety assessed by the State Anxiety Scale of Spielberg's State-Trait Anxiety Inventory, blood pressure, and pulse were measured at enrollment and before gastroscopy. The information seekers and avoiders who received additional sensory information experienced significantly less state anxiety after the intervention. In contrast, the information seekers and avoiders who received standardized procedural information maintained their preintervention state anxiety level. Most patients reported their preference for sensory information. In conclusion, the provision of sensory information could significantly reduce patients' pregastroscopy anxiety regardless of patients' information coping style.

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

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.

The effects of a designer music intervention on patients' anxiety, pain, and experience of colonoscopy: a short report on a pilot study

There is a controversy on whether listening to music before or during colonoscopy reduces anxiety and pain and improves satisfaction and compliance with the procedure. This study aimed to establish whether specifically designed music significantly affects anxiety, pain, and experience associated with colonoscopy. In this semirandomized controlled study, 34 patients undergoing a colonoscopy were provided with either muted headphones (n = 17) or headphones playing the investigator-selected music (n = 17) for 10 minutes before and during colonoscopy. Anxiety, pain, sedation dose, and overall experience were measured using quantitative measures and scales. Participants' state anxiety decreased over time (P < .001). However, music did not significantly reduce anxiety (P = .441), pain scores (P = .313), or midazolam (P = .327) or fentanyl doses (P = .295). Despite these findings, 100% of the music group indicated that they would want music if they were to repeat the procedure, as compared with only 50% of those in the nonmusic group wanting to wear muted headphones. Although no significant effects of music on pain, anxiety, and sedation were found, a clear preference for music was expressed, therefore warranting further research on this subject.

Education for Ward Nurses Influences the Quality of Inpatient's Bowel Preparation for Colonoscopy

Although adequate bowel preparation is a prerequisite for colonoscopy, preparation among inpatients is often suboptimal. This study aimed to evaluate the impact of ward nurse education on the quality of bowel preparation of inpatients.A prospective, double-blinded, non-randomized, controlled study was performed. Expert endoscopists provided enhanced education to nurses who belonged to an "educated ward" followed by training that was repeated every week for 1 month. The primary outcome was the quality of the bowel preparation, which was based on the Ottawa Bowel Preparation Scale (OBPS). Patient compliance and their subjective feelings and the factors affecting inadequate bowel preparation were also analyzed.One hundred three inpatients in the educated ward and 102 patients in the control ward were enrolled. Baseline data were comparable between the 2 wards. The mean values of the total OBPS scores were 4.42 ± 2.23 and 6.15 ± 2.38 in the educated and control wards, respectively (P < 0.001). The rate of poor preparation (OBPS ≥ 6) in the educated ward was significantly lower than that in the control ward (31.1% vs 58.8%, P < 0.001). Compliance with preparation and diet instructions in the educated ward was superior to that in the control ward (P<0.001). Control patients were more likely to be anxious before colonoscopy (P < 0.001), whereas patients in the educated ward showed higher level of satisfaction (P = 0.001) and better sleep quality (P < 0.001). A lack of ward nurse education (OR 2.365, P = 0.025), constipation (OR 6.517, P < 0.001), and insufficient water ingestion (OR 2.044, P = 0.042) were independently associated with inadequate bowel preparation among inpatients.Ward nurse education effectively improved the quality of bowel preparation, and relevant colonoscopic outcomes among inpatients. Additional efforts are needed to control constipation and to encourage additional water ingestion in inpatients for better bowel preparation.

The experience of anxiety in colonoscopy outpatients: a mixed-method study

Colonoscopy is commonly used to investigate gastrointestinal symptoms such as pain or changes in bowel habits and may either induce patient anxiety or assist in patient reassurance. Currently, 2 studies investigating negative colonoscopy, reassurance, and anxiety came to conflicting conclusions on this issue. Furthermore, it is possible that differences in coping styles may influence patient anxiety. A mixed-methods study was conducted with 26 precolonoscopy and 24 postcolonoscopy patients to address the conflicting, limited literature regarding colonoscopy, coping, and anxiety. Participants completed postal surveys and interviews were conducted with 16 participants. There was no significant difference between pre- and postcolonoscopy groups on any anxiety measures; however, this was possibly because of individual differences. Significant positive correlations were found between maladaptive coping and state anxiety indicating that healthcare professionals should consider screening for maladaptive coping in patients needing invasive procedures. Neither problem- nor emotion-focused coping showed any significant relationship with state anxiety. Interviews revealed that clinicians and endoscopy nurses should be aware that some patients are not absorbing correct information about colonoscopy, specifically that they may be conscious or experience pain during the procedure. Because of this, clinicians should ensure that patients understand standard practice at their hospital. In addition, interview data suggested that more attention should be given to pain management as it currently may not be adequate during conscious sedation.

Quality in colonoscopy: European perspectives and practice

Colonoscopy is the 'gold standard' investigation of the colon. High quality colonoscopy is essential to diagnose early cancer and reduce its incidence through the detection and removal of pre-malignant adenomas. In this review, we discuss the key components of a high quality colonoscopy, review methods for improving quality, emerging technologies that have the potential to improve quality and highlight areas for future work.

The effects of preference for information on consumers' online health information search behavior

BACKGROUND

Preference for information is a personality trait that affects people's tendency to seek information in health-related situations. Prior studies have focused primarily on investigating its impact on patient-provider communication and on the implications for designing information interventions that prepare patients for medical procedures. Few studies have examined its impact on general consumers' interactions with Web-based search engines for health information or the implications for designing more effective health information search systems.

OBJECTIVE

This study intends to fill this gap by investigating the impact of preference for information on the search behavior of general consumers seeking health information, their perceptions of search tasks (representing information needs), and user experience with search systems.

METHODS

Forty general consumers who had previously searched for health information online participated in the study in our usability lab. Preference for information was measured using Miller's Monitor-Blunter Style Scale (MBSS) and the Krantz Health Opinion Survey-Information Scale (KHOS-I). Each participant completed four simulated health information search tasks: two look-up (fact-finding) and two exploratory. Their behaviors while interacting with the search systems were automatically logged and ratings of their perceptions of tasks and user experience with the systems were collected using Likert-scale questionnaires.

RESULTS

The MBSS showed low reliability with the participants (Monitoring subscale: Cronbach alpha=.53; Blunting subscale: Cronbach alpha=.35). Thus, no further analyses were performed based on the scale. KHOS-I had sufficient reliability (Cronbach alpha=.77). Participants were classified into low- and high-preference groups based on their KHOS-I scores. The high-preference group submitted significantly shorter queries when completing the look-up tasks (P=.02). The high-preference group made a significantly higher percentage of parallel movements in query reformulation than did the low-preference group (P=.04), whereas the low-preference group made a significantly higher percentage of new concept movements than the high-preference group when completing the exploratory tasks (P=.01). The high-preference group found the exploratory tasks to be significantly more difficult (P=.05) and the systems to be less useful (P=.04) than did the low-preference group.

CONCLUSIONS

Preference for information has an impact on the search behavior of general consumers seeking health information. Those with a high preference were more likely to use more general queries when searching for specific factual information and to develop more complex mental representations of health concerns of an exploratory nature and try different combinations of concepts to explore these concerns. High-preference users were also more demanding on the system. Health information search systems should be tailored to fit individuals' information preferences.

Magnetic endoscopic imaging during colonoscopy is associated with less pain and decreased need of analgesia and sedation--results from a randomized controlled trial

OBJECTIVE

Colonoscopy is the method of choice for examining patients with lower gastrointestinal symptoms. The procedure is, however, in many cases, associated with pain and impaired compliance. Magnetic endoscopic imaging (MEI) generates a three-dimensional image of the colonoscope on a computer screen which may enable the colonoscopist to avoid looping, and consequently improve patient satisfaction.

MATERIAL AND METHODS

In this randomized controlled trial, 200 outpatients referred to colonoscopy at Østfold Hospital Trust, Fredrikstad, Norway, were included. Patients were randomized to either the standard arm (using fluoroscopy on demand, n = 100), or the MEI arm (n = 100). End points were time to cecum, subjective pain experiences, and use of sedation or analgesics.

RESULTS

Out of a total of 200 patients, 54% were men. However, no significant differences between the groups according to gender were found. Fluoroscopy was applied in 23% of the cases in the standard group. Use of MEI was associated with decreased time to cecum (p < 0.05), decreased pain scores (Visual Analogue Scale, p < 0.05), decreased need of analgesia (p < 0.01), and decreased amount of administered midazolam and pethidin (p < 0.05 in both).

CONCLUSIONS

MEI during colonoscopy was associated with decreased pain and less on-demand requests for sedation and analgesia. In addition, the use of MEI reduced the cecal intubation time. Consequently the implementation of magnetic endoscopic imaging in the endoscopy suits may be beneficial, particularly in the clinically difficult cases.

Impact of self-watching double j stent insertion on pain experience of male patients: a randomized control study using visual analog scale

Objective. To confirm safety and feasibility of double J stent insertion under local anesthesia and to assess the effect of detailed explanation and observing double J stent insertion on pain experience of male patients. Material and Methods. Eighty consenting males, randomized and divided prospectively into group A, who were allowed to observe DJ stent insertion, and group B, were not observed. All DJ stent insertions were done by senior urologist in operating urology room with or without fluoroscopy guidance. At the end of the procedure the vital signs and duration of the procedure were documented and patients were asked to fill unmarked 100 mm visual analogue pain scale (VAS) as soon as the surgeon leaves operating room. Results. Mean age of entire study group was 38.8 years; the majority of the patients had DJ stent insertion for obstructed ureteric stone, with uneventful outcomes. Postprocedural systolic blood pressure and mean pain using VAS showed statistically significant difference between groups A and B. Conclusion. DJ stent insertion under local anesthesia is a safe and feasible procedure. We recommended self-watching and detailed explanation to patients who underwent DJ stent insertion to reduce the pain and anxiety associated with the procedure.

Effects of written plus oral information vs. oral information alone on precolonoscopy anxiety

AIMS AND OBJECTIVES

To determine the effect of written plus oral information vs. oral information alone on precolonoscopy anxiety.

BACKGROUND

Information provision has been considered to reduce precolonoscopy anxiety. However, the best means to provide information before colonoscopy has not yet been determined as there is inconsistency in the outcomes of the clinical trials.

DESIGN

A two-group, pretest, post-test, prospective, quasi-experimental design with non-random assignment.

METHODS

Participants were assigned to group 1 or 2 in the study. In the enrolment all the participants completed the questionnaires to collect personal characteristics data and assessed subjects' anxiety level by the Chinese version of the State Scale of State-Trait Anxiety Inventory as baseline data. After that, subjects in group 1 received written plus oral information before colonoscopy, while those in group 2 received oral information before colonoscopy. On the day for colonoscopy all subjects completed the Chinese version of the State Scale of State-Trait Anxiety Inventory again.

RESULTS

There was no difference in state anxiety and personal characteristic between the two groups at enrolment. After the intervention, although the state anxiety scores were dropped, there were no statistical significant differences between two groups or within groups 1 and 2.

CONCLUSIONS

Information provision before colonoscopy did not reduce the anxiety level in patients directly before colonoscopy.

RELEVANCE TO CLINICAL PRACTICE

There was a trend that information had a positive effect on patients' state anxiety. Future information provision studies may need to add more interactive methods appropriately and take patients' gender, educational level and coping style into consideration.

A prospective audit of patient experiences in colonoscopy using the Global Rating Scale: a cohort of 1,187 patients

BACKGROUND

The Global Rating Scale (GRS) comprehensively evaluates the quality of an endoscopy department, providing a patient-centred framework for service improvement.

OBJECTIVE

To assess patient experiences during colonoscopy and identify areas that need service improvement using the GRS.

METHODS

Consecutive outpatients undergoing colonoscopy were asked to complete a pre- and postprocedure questionnaire. Questions were based on GRS items and a literature review. The preprocedure questionnaire addressed items such as patient characteristics and information provision. The postprocedure questionnaire contained questions regarding comfort, sedation, the attitude of endoscopy staff and aftercare.

RESULTS

The preprocedure questionnaire was completed by 1,187 patients, whereas the postprocedure part of the questionnaire was completed by 851 patients (71.9%). Fifty-four per cent of patients were first seen in the outpatient clinic. The indication for colonoscopy was explained to 85% of the patients. Sixty-five per cent of the patients stated that information about the risks of colonoscopy was provided. Sedation was used in 94% of the patients; however, 23% judged the colonoscopy to be more uncomfortable than expected. Ten per cent of patients rated the colonoscopy as (very) uncomfortable. Preliminary results of the colonoscopy were discussed with 87% of patients after the procedure. Twenty-one per cent of the patients left the hospital without knowing how to obtain their final results. Being comfortable while waiting for the procedure (OR 9.93) and a less uncomfortable procedure than expected (OR 2.99) were important determinants of the willingness to return for colonoscopy.

CONCLUSIONS

The present study provided evidence supporting the GRS in identifying service gaps in the quality of patient experiences for colonoscopy in a North American setting. Assessing experiences is useful in identifying areas that need improvement such as the provision of pre- and postprocedure information.

Influence of additional post-bronchoscopy visit on patient satisfaction after flexible bronchoscopy

BACKGROUND/AIMS

Many patients undergoing a flexible bronchoscopy (FB) experience anxiety and discomfort during the procedure. We assessed whether an additional patient visit after a FB would improve patient satisfaction.

METHODS

The study patients were randomly assigned to a control and post-visit groups. The physicians who were scheduled to perform the FB visited the study patients. The control group had one visit before the FB and the post-visit group had a before and after FB visit. The post-visit group received additional information and support during the second visit. Twenty-four hours after the FB, the participants completed questionnaires about discomfort and satisfaction with the procedure.

RESULTS

The control and post-visit groups included 151 and 153 patients, respectively. The post-visit group reported having more information after the FB than the control group. The additional post-bronchoscopy visit improved the general patient tolerability of the procedure. The willingness to return for another FB was not affected by the post-bronchoscopy patient visit.

CONCLUSIONS

The post-bronchoscopy visit improved patient satisfaction and general tolerability to the procedure. Subjective patient tolerability with the FB may be improved through a post-bronchoscopy visit by providing more information and emotional support to patients.

The effectiveness of clinical hypnosis in the digestive endoscopy: a multiple case report

The aim of this study is to evaluate the efficacy and viability of hypnosis before and during a gastrointestinal endoscopy. Six Gastroscopies and 22 colonoscopies were carried out under hypnosis in a group of patients. The patients ranged in age from 20 and 67 years and have a history of previously incomplete and poorly tolerated examinations or expressed an active demand for sedation. For 6 of the patients who underwent a gastroscopy under hypnosis, the procedure was successfully completed, reaching the second part of the duodenum without difficulty for the endoscopist. Colonoscopy of the cecum was completed in 19 of 20 patients. All patients, except 1, considered their tolerance level as "good." Hypnosis facilitated an adequate endoscopy intervention without any discomfort in 85% of the cases examined. Avoidance of anaesthesia reduces risk to the patient. Hence, hypnosis for gastrointestinal endoscopy appears to provide a promising strategy.

A comparison of patient acceptance and preferences between CT colonography and conventional colonoscopy in colorectal cancer screening

BACKGROUND/AIMS

Colorectal cancer, one of the most common cancers in developed countries, is curable when diagnosed at an early stage. However, for better screening, both a test that patients will tolerate and diagnostic accuracy are required. We compared patient experiences and preferences between computed tomographic (CT) colonography and conventional colonoscopy (CC) under conscious sedation.

METHODS

Patients referred to the gastrointestinal clinic for CC were enrolled to also undergo CT colonography prior to CC. After each procedure, patients completed a questionnaire in which variables, such as abdominal pain, abdominal discomfort, and loss of dignity, were assessed using a 7-point Likert scale, with the highest score representing the worst experience. To verify response stability, a telephone questionnaire followed within 24 h after each procedure. Patients were then asked about their preference for CT colonography or CC.

RESULTS

Data were collected from 51 patients who fulfilled all requirements, including CT colonography, CC, the two questionnaires after each procedure, and a follow-up questionnaire. Severity of abdominal pain, abdominal discomfort, and a loss of dignity were reported to be higher in CT colonography than in CC (p<0.01). In addition, the preference for CC was significantly higher than that for CT colonography (p<0.01).

CONCLUSIONS

Although CT colonography is a safe and noninvasive screening test for colorectal cancer, further study is required to increase patient acceptance.

The difficult-to-sedate patient in the endoscopy suite

More than 20 million endoscopic procedures are performed in the United States annually. More than 98% of these endoscopies are performed with sedation. This includes both diagnostic and therapeutic procedures. Sedation reduces a patient's anxiety and discomfort, often improving their satisfaction with the procedure. Sedation creates a relaxed patient and a relaxed procedure environment allowing for a successful endoscopic examination.

Clinical outcomes associated with attempts to educate patients about lower endoscopy: a narrative review

Patient knowledge about lower endoscopy might have beneficial effects on satisfaction outcomes, pre-procedure anxiety, and adherence, although this is poorly understood. Methods Searching the national and international literature, we reviewed 20 years of observational studies and randomized trials that examine possible relationships between educating patients about lower endoscopy and clinical outcomes. Twenty-three publications were included but their heterogeneity precluded meta-analyses. Standard and modified informed consent procedures and enhanced educational interventions were associated most often with levels of patient knowledge, satisfaction, anxiety, and adherence. Regardless of the approach, a large proportion of patients have poor comprehension of lower endoscopy's risks, benefits, and alternatives; patient satisfaction with information and procedures manifests ceiling effects; only a subset of patients have clinically significant pre-procedure anxiety; and providing written information and reminders may improve procedure adherence. Future work should focus on strategies for improving patient knowledge in the setting of initial screening colonoscopy within open access systems. Patient knowledge of lower endoscopy is often inadequate even though greater knowledge might be associated with better clinical outcomes for certain patient subgroups. Professional societies have an important role to play in endorsing educational strategies and in clarifying and assessing the adequacy of patient knowledge.

Monitoring and blunting in palliative and curative radiotherapy consultations

OBJECTIVE

The present research paper investigates how cancer patients' monitoring and blunting coping styles are reflected in their communications during their initial radiotherapy consultations and in their evaluations of the consultation. Additionally, it is explored how a patient's disease status (curative versus palliative) influences the effects of his or her cognitive styles.

METHODS

The study included 116 oncology patients receiving treatment from eight radiation oncologists. For 56 patients treatment intent was palliative and for the remaining 60 curative. The patients' communicative behaviors were assessed using the Roter Interaction Analysis System (RIAS). Within three days the patients completed a monitoring and blunting inventory and after another six weeks they evaluated the treatment decision and treatment information by postal questionnaire.

RESULTS

Monitoring was positively and blunting negatively related to the patient's expression of questions, emotions and decision-making issues. After six weeks 'high monitors' as opposed to 'low monitors' reported having more doubts about the treatment decision and being less satisfied with the information received while 'high blunters' expressed fewer doubts and more satisfaction than 'low blunters' did. Significant associations were all attributable to the palliative treatment group.

CONCLUSION

Cancer patients' communicative behaviors vis-à-vis their oncologist hinge on their cognitive styles and an unfavorable disease status enhances the effects.

An instrument to predict endoscopy tolerance: a prospective randomized study

Our purpose in this study was to determine if the use of an instrument developed by our group to direct sedation choice improves patient satisfaction with endoscopy sedation compared to standard sedation practice. After 200 enrollments, data were available for 194 patients who completed the study. There were nine cases of dissatisfaction: five (5%) in the control group and four (4%) in the intervention group (P = 0.78). The 95% confidence intervals (1%-10%) were almost identical, indicating no difference between groups. The study was stopped after an interim analysis showed no significant difference in satisfaction between the groups. This could have been because the assumption that patients with increased risk of dissatisfaction do better with deeper sedation is incorrect. Another explanation could be the increased awareness of the value of benzodiazepines in endoscopy. Consistent with our findings, nervousness rather than pain predicted dissatisfaction, and the optimal use of anxiolytics with amnesic properties may be comparable to that of propofol.

The effect of information level and coping style on pain and anxiety in needle liver biopsy

Biopsy of the liver is an important diagnostic procedure. The procedure is invasive and may be painful for patients. Sedative drugs are not used because the associated drop in blood pressure mimics hemorrhage, a major complication of the procedure. Cognitive and behavioural techniques have been used to decrease stress in patients undergoing other medical procedures. In the present study, it is postulated that providing procedural and sensory information may reduce patient anxiety levels. Patient coping styles were evaluated and anxiety and pain levels were assessed by using a visual analogue scale. Subjects were randomly assigned to one of two groups. The control group received basic information about the procedure. The experimental group received the same basic information followed by more detailed educational information. Subjects also filled out the Krantz Health Opinion Survey, a short questionnaire used to classify coping styles as either information-seeking or information-avoiding. Seventy-five subjects (38 control and 37 experimental) with similar demographics were included in the present study. No significant differences were found in anxiety levels or pain levels 30 min and 6 h post-biopsy. There was also no significant difference between groups once coping style was added into the analysis. The study failed to show any advantage in providing additional information to subjects before liver biopsy, regardless of coping style.

The effect of an information brochure on patients undergoing gastrointestinal endoscopy: a randomized controlled study

OBJECTIVE

The aim of the present study was to test the potential beneficial effects of an information brochure on undergoing a gastrointestinal endoscopy for the first time. The information provided was based on self-regulation theory, and patients could restrict themselves to reading the summary only.

METHODS

Patients were randomly assigned to an experimental group receiving the brochure at least 1 day before the gastroscopy (N=47), or to a control group not receiving the brochure (N=48).

RESULTS

The results show that all experimental subjects, except one, fully read the brochure. Those receiving the brochure experienced less anxiety before the gastroscopy and, afterwards, they reported greater satisfaction with the preparation for it. With regard to coping style there were some small moderating effects into the direction expected: low blunters (those not seeking distraction under impending threat) as compared to high blunters showed extra reduced anxiety after reading the brochure. They also tended to read the brochure more often. High monitors (those seeking information under impending threat) receiving the brochure showed reduced anxiety during the gastroscopy as compared to low monitors (tendency).

CONCLUSION

We conclude that providing patients with the developed brochure constitutes an efficient, beneficial intervention.

PRACTICE IMPLICATIONS

The brochure could easily be implemented in standard practice without the necessity to take the patient's coping style into account.

Development of an instrument to assess and predict satisfaction and poor tolerance among patients undergoing endoscopic procedures

We aimed to test the reliability of a developed questionnaire that measures and predict aversive endoscopic experience. Two questionnaires (pre- and postprocedure) were given to patients presenting for routine endoscopy. The first questionnaire elicited demographics, prior endoscopic experience, history of drug or alcohol use, patient expectations, and levels of anxiety and nervousness before procedure. After endoscopy, tolerance and willingness to repeat the examination were determined. The primary outcome of "adverse endoscopic experience" (AEE) was defined as a score of > or =5 on the postprocedure overall level of satisfaction or unwillingness to repeat endoscopy. Thirteen of 148 subjects reported an AEE. Items measuring the primary outcome were internally validated by reliability analysis which significantly correlated with measures of aversive experience like pain, nervousness, and suffering during the procedure. Preprocedure factors that were associated with AEE in the univariate analysis and multivariate analysis were nervousness (P = 0.02) and chronic use of psychotropic drugs or alcohol (P = 0.03). In conclusion, we have developed a questionnaire that reliably measures aversive endoscopic experience. Nervousness before procedure and chronic use of psychotropic drugs are reliable predictors of such experience.

Preprocedure patient values regarding sedation for colonoscopy

BACKGROUND

Adherence rates for screening colonoscopy remain low. There are little data describing pre-colonoscopy patient concepts, values, and preferences for sedation during colonoscopy. In this study, we sought to investigate preprocedure patient values regarding sedation use for colonoscopy.

METHODS

Questionnaires were administered to 210 consecutive outpatients presenting for colonoscopy. An unscaled visual analog scale was used to value each of eight statements relating to sedation.

RESULTS

The statement receiving the highest valuation was "I don't want to feel any pain" (mean score, 82 +/- 21), followed by "I want to go to sleep and not wake up until the procedure is over" (mean score, 71 +/- 31), and "I want to be alert as soon as possible after the procedure" (mean score, 65 +/- 30). The statement receiving the lowest value was "I'd like to watch as much of the procedure as I can" (22 +/- 29). Patients who preferred to undergo colonoscopy without sedation were more likely to be men (P = 0.001) and more likely to have graduate or professional educational degrees (P < 0.001).

CONCLUSIONS

Our data suggest that, on average, American patients place the highest valuation on experiencing no pain during colonoscopy, waking up promptly after the procedure, and for going to sleep and not waking up until the procedure is over. However, unsedated colonoscopy does appeal to a small minority of patients, primarily men with graduate educations.

Modeling Pathways to Affective Barriers on Colorectal Cancer Screening Among Japanese Americans

The study aimed to identify the mechanisms through which colorectal cancer (CRC)-specific affective barriers, including fear of finding CRC, embarrassment, and concerns for screening discomfort, can be reduced to guide the development of interventions aimed at the secondary prevention of CRC. A model explaining these affective barriers was developed and tested among a random sample of 305 asymptomatic Japanese Americans using a path analysis. The model suggested that affective barriers could be reduced by increasing CRC-related knowledge, which could be enhanced by acculturation, social support, and physician recommendation. Interventions that focus on increasing CRC-related knowledge could reduce affective barriers to CRC screening for this population when taking the enhancement of communication skills and interpersonal interactions into account.

Prospective comparison of air-contrast barium enema and colonoscopy in patients with fecal occult blood: a pilot study

BACKGROUND

The utility of air-contrast barium enema and colonoscopy for evaluation of the colon has been debated. Air-contrast barium enema is less expensive and invasive than colonoscopy, but it also is less sensitive and specific. Further, although air-contrast barium enema may be less painful than colonoscopy, it often is poorly tolerated by patients. Thus, this study compared the sensitivity and the specificity of air-contrast barium enema and colonoscopy for detection of colonic lesions in patients with fecal occult blood.

METHODS

Over a 30-month period, patients with fecal occult blood were recruited. Patients underwent standard air-contrast barium enema, followed by colonoscopy 7 to 14 days later. Colonoscopists were blinded to the results of air-contrast barium enema until the colonoscopy was completed, after which the results were disclosed. If the findings were discrepant, colonoscopy was repeated.

RESULTS

A total of 100 patients were evaluated. Nine air-contrast barium enemas were reported to be inadequate, and the cecum was not intubated at colonoscopy in two patients. In the remaining patients, 5 cancers were identified (1 each cecum, transverse colon, descending colon, sigmoid colon, and rectum) by both studies. Sixty-six polypoid lesions were identified in 30 patients. Diverticula were identified in 42 patients by air-contrast barium enema and in 18 patients by colonoscopy. Air-contrast barium enema detected 3 of 36 polypoid lesions 5 mm or less in diameter, 5 of 15 adenomas 6 to 9 mm in size, and 4 of 15 adenomas 10 mm or greater in diameter (sensitivity 8%, 33%, and 27%, respectively). After excluding patients with diverticula, air-contrast barium enema detected 3 of 7 adenomas 10 mm or greater in size. Overall, 12 polypoid lesions or filling defects were identified by air-contrast barium enema that could not be verified by colonoscopy. The specificity of air-contrast barium enema for lesions 1.0 cm or greater in size was 100%; for those 6 mm or greater, it was 97%.

CONCLUSIONS

Air-contrast barium enema accurately detects colon cancer and diverticula. Its sensitivity for detection of polypoid lesions or adenomas is poor and was confounded by the presence of diverticula.

Effects on pain and anxiety of patients viewing their cystoscopy in addition to a detailed explanation: a controlled study

OBJECTIVE

To compare the effect of allowing patients to watch their cystoscopy on closed-circuit television and with an explanation during the procedure, with an explanation alone, as involving patients in the process of minimally invasive procedures like colonoscopy or colposcopy has been reported to alleviate pain and anxiety, but these effects may differ in patients who desire participation and those who do not.

PATIENTS AND METHODS

Of 51 patients undergoing cystoscopy for the first time, 27 watched the procedure and received explanations, and 24 received explanations alone. They completed an anxiety questionnaire and visual analogue scales (VAS) of anxiety before and after the procedure. Before the procedure they also completed an assessment of desire to be involved in medical decisions and procedures (Kranz Health Opinion Survey, KHOS), and afterwards recorded the pain they had experienced on a scale of 1-10.

RESULTS

Anxiety (assessed by VAS) declined after the procedure (P < 0.001) but the anxiety questionnaire showed no change. There was a positive correlation between the KHOS and VAS after the procedure; the more the patient was an 'information seeker' the higher the anxiety. Neither pain nor anxiety were affected by watching the monitor, whether or not KHOS scores were entered as a cofactor. Age and sex had no effect on the results. There were no complications.

CONCLUSION

There was no effect of watching the cystoscopy on anxiety and pain. Possibly the explanation received by both groups left no room for further improvement in the intervention group.

A music intervention to reduce anxiety prior to gastrointestinal procedures

Patients scheduled for gastrointestinal procedures such as colonoscopy or esophagogastroduodenoscopy are often anxious and frightened. High levels of anxiety may result in more difficult and painful procedures. Past research has reported education, coping skills, relaxation techniques, and combinations of these including music, have decreased anxiety in patients across many settings. Self-selected music therapy for preprocedural anxiety has not been studied. A randomized controlled trial of 198 patients was undertaken to determine whether 15 minutes of self-selected music reduced preprocedure anxiety. The State Trait Anxiety Inventory was used to measure patients' anxiety. One-hundred ninety-three men and 5 women comprised the sample with an average age of 61 (SD 10.5). Patients who listened to music (n = 100) reduced their anxiety score from 36.7 (SD 9.1) to 32.3 (SD 10.4), while those who did not listen to music (n = 98) reduced their anxiety score from 36.1 (SD 8.3) to 34.6 (SD 11.5). These differences were statistically significant (F = 7.5, p =.007) after controlling for trait anxiety. There were no significant vital sign changes premusic and postmusic. Music is a noninvasive nursing intervention that can significantly reduce patients' anxiety prior to gastrointestinal procedures. Further research should address using music to reduce anxiety in other procedure areas and testing effectiveness of self-selected versus investigator-selected music in reducing anxiety.

Effects of video information on preoperative anxiety level and tolerability of joint lavage in knee osteoarthritis

OBJECTIVE

To investigate the impact of video information on preoperative anxiety of patients scheduled to undergo joint lavage for knee osteoarthritis, and tolerability of the lavage.

METHODS

A video film on joint lavage (duration 4 minutes, 20 seconds) was made by medical communication professionals, based on recommendations of the medical and paramedical staff of the Institute of Rheumatology. Patients diagnosed with knee osteoarthritis and scheduled for lavage were assigned, using a preestablished list of randomization, to either the video group or the no-video group. In the operating room, preoperative anxiety level was measured on a 100-mm visual analog scale (VAS), and tolerability was assessed using a 4-grade scale.

RESULTS

One hundred twelve patients (56 patients in each group) were included and completed the trial. Preoperative anxiety was lower by half for patients who had viewed the video (VAS 13 +/- 20 versus 26 +/- 27; P = 0.0056). Tolerability of knee lavage was also significantly better in the video group (very tolerable 91% versus 48%; P < 0.0001).

CONCLUSION

This prospective, controlled, randomized study confirms the usefulness of video information prior to an invasive rheumatology procedure.

Patient experience and preferences toward colon cancer screening: a comparison of virtual colonoscopy and conventional colonoscopy

BACKGROUND

Virtual colonoscopy has excellent sensitivity for the detection of cancer and polyps greater than 1 cm in diameter. For virtual colonoscopy to succeed as a screening test for colorectal neoplasia, it must be well tolerated and accepted by patients. Patients' experiences with virtual colonoscopy and conventional colonoscopy were assessed and compared.

METHODS

Patients referred to the GI clinic for colonoscopy for any indication were recruited to undergo virtual colonoscopy before conventional colonoscopy. Patients were asked to complete a questionnaire twice: after virtual colonoscopy and after completing both tests. Three variables, overall pain, discomfort, and lack of respect, were assessed by using a 7-point Liken scale with higher scores denoting a worse experience. Patients' preferences for virtual colonoscopy versus conventional colonoscopy were determined with a time tradeoff technique. To verify response stability, patients were asked to return an additional questionnaire by mail at 24 hours.

RESULTS

Two hundred ninety-five patients completed the questionnaire immediately after the procedures, and 83 patients completed the questionnaire at 24 hours. At both 0 and 24 hours, patients reported more pain, discomfort, and less respect after virtual colonoscopy than conventional colonoscopy (p < 0.01). The overall agreement (Kappa statistic) between times 0 and 24 hours was fair. Patients reported that they preferred conventional colonoscopy and would wait longer for conventional colonoscopy (mean = 4.9 weeks) than undergo a virtual colonoscopy (p < 0.01).

CONCLUSIONS

Patients tolerate both virtual colonoscopy and conventional colonoscopy, although they report more pain, discomfort, and less respect undergoing virtual colonoscopy. Efforts to improve patient experience during virtual colonoscopy need to be investigated.

A patient education program is cost-effective for preventing failure of endoscopic procedures in a gastroenterology department

OBJECTIVE

The growing use and complexity of endoscopy procedures in GI units has increased the need for good patient preparation. Earlier studies in this area have focused on the psychological benefits of patient education programs. The present study was directed at determining cost-effectiveness of a patient education program.

METHODS

A prospective, randomized, controlled design was used. The patient population consisted of 142 patients aged 18-90 yr referred for an endoscopy procedure. Ninety-one (64%) participated in a targeted educational session conducted by a dedicated departmental nurse (group 1), 38 (27%) did not (group 2), and 13 (9%) received telephonic instruction (group 3). Before the endoscopy, all patients completed a questionnaire covering background data, endoscopy-related variables, anxiety level, and satisfaction. Patient cooperation and success/failure of the procedure were documented by the attending nurse.

RESULTS

Male gender, previous endoscopy, and explanation from the referring physician were associated with a low level of anxiety (p < 0.05). There was a significant association between attendance in the education program and success of the endoscopy (p = 0.0009). Cancellations of procedures because of poor preparation occurred in 4.39% of group 1 in comparison with 26.31% and 15.38% of groups 2 and 3, respectively (p = 0.005). The overall cost of the procedure was reduced by 8.6%, 8.9%, and 5.5% for gastroscopy, colonoscopy, and sigmoidoscopy, respectively. All participants expressed satisfaction with the brochure.

CONCLUSION

A pre-endoscopy patient education program apparently increase patient compliance, thereby decreasing both the need for repeated examinations and their attendant costs.

A randomized controlled trial of total colonic decompression after colonoscopy to improve patient comfort

OBJECTIVES

Bloating occurring after colonoscopy may cause significant discomfort in some patients. We sought to determine whether total colonic decompression decreased bloating and improved comfort after colonoscopy.

METHODS

Consecutive outpatients undergoing elective colonoscopy were randomized to total colonic decompression or to the control group after completion of the routine colonoscopy. The colonoscope was advanced again to the cecum and the air aspirated during withdrawal in patients randomized to decompression and the procedure was terminated without decompression in control patients. Pain and bloating was assessed in the recovery room and in 24-48 h using a five-point scale.

RESULTS

Sixty-five patients were randomized to decompression and 61 were randomized to the control group. The baseline demographic and procedural characteristics were similar between the two groups, but decompression took significantly longer (median, 17 min vs 14 min, p = 0.0002). Seventy-five percent of the decompression group and 80% of the control group denied any pain during colonoscopy. Significantly fewer patients from the decompression group complained of bloating after the procedure (25% vs 59%, p < 0.001) when questioned in the recovery room. However, comparable patients complained of postprocedure bloating when questioned in 24-48 h after the procedure (45% of decompression group vs 47% of control group, p = 0.86). The nurse and the endoscopist were poor at predicting the patient's bloating and significantly overestimated the level of pain.

CONCLUSIONS

Total colonic decompression does not significantly reduce bloating after colonoscopy when assessed 24-48 h after the procedure.

Factors that predict incomplete colonoscopy: thinner is not always better

OBJECTIVE

The aim of this study was to determine whether anatomic factors such as body mass index (BMI) impacts the success rate of cecal intubation during colonoscopy.

METHODS

We retrospectively reviewed the cecal intubation rate of 2000 colonoscopies performed at our institution from March 1997 to March 1999. The analysis sample was composed of charts for all incomplete procedures and a sample (23%) of complete examinations that were randomly selected. Data collected included age, gender, height, weight, bowel habits, abdominal surgery, psychiatric medication use, the presence of diverticular disease, amount of sedation administered, and location and reason for halting the examination. Patients were divided by BMI: thin (BMI < or = 22.1), average weight (BMI > 22.1-25.0), overweight (BMI = 25.1-29.9), and obese (BMI > 30).

RESULTS

Colonoscopies in women had a lower adjusted completion rate (94.8%) than in men (98.2%) (p < 0.005). A low BMI in women was predictive of an incomplete examination (p < 0.001). Factors that did not predict incomplete examinations in women included age and previous hysterectomy. The small number of male patients with an incomplete examination (n = 16) precluded accurate identification of any factors.

CONCLUSIONS

Women with a low BMI (especially < 22) were more likely to have an incomplete procedure. This finding may have implications for colorectal cancer screening in female patients.

Predictors of pain control in patients undergoing flexible bronchoscopy

The purpose of this study was to assess the extent to which patients undergoing flexible bronchoscopy (FOB) experience pain and to identify patient factors and process of care factors that are associated with pain. We conducted a prospective cohort study on 481 patients undergoing FOB. Overall control of pain during FOB was the primary outcome. The mean age of the patients was 48 yr, 50% were male, and 32% required supplemental oxygen prior to FOB. Pain control was excellent in 36% of patients, but 10% considered it to be fair or poor. Patient factors associated with excellent pain control were excellent health (versus poor health, OR = 6.25 [95% CI, 2.28-16.67]), more education (college education versus high school education, OR = 1.72 [95% CI, 1.05-2.86]), and not having asthma (OR = 2.86 [95% CI, 1.09-7.14]). Process of care factors associated with excellent pain control were not being bothered by scope insertion (versus bothered, OR = 3.65 [95% CI, 1.99-6.98]), no memory of FOB (versus some memory, OR = 2.33 [95% CI, 1.24-4.44]), and higher ratings of information about the procedure (per 1-point increase on a 12-point scale, OR = 1.57 [95% CI, 1.41-1.78]). This is the first large-scale, prospective study to evaluate patient and process of care factors that influence pain control during FOB. It demonstrated that there are patient characteristics and process of care factors that need to be considered when evaluating pain during bronchoscopy. Improved preparation of patients with lower education, inferior health status, and asthma may lead to decreased pain during FOB. Bronchoscopists may be able to reduce pain during FOB by identifying methods to decrease pain on scope insertion, by improving the information provided to patients, and by achieving greater levels of amnesia during FOB.

Anesthesia and sedation in the endoscopy suite? (influences and options)

Advances in technology and pharmacology have enabled gastrointestinal endoscopists to expand the diagnostic and therapeutic capabilities of the specialty. Research into the impact of the endoscopy environment on patient stress, acknowledgement of the various patient coping styles, development and deployment of procedural preparative programs and information streamlining have been shown to be of value in decreasing anxiety and reducing sedative requirements. Being aware of procedure-related stressors, and factors associated with complications, allows us to tailor our sedation or anesthesia plan to the individual patient.