Patient experiences of colonoscopy, barium enema and CT colonography: a qualitative study

Abstract

Previous studies of patient experience with bowel screening tests, in particular CT colonography (CTC), have superimposed global rating scales and not explored individual experience in detail. To redress this, we performed qualitative interviews in order to characterize patient expectations and experiences in depth. Following ethical permission, 16 patients undergoing CTC, 18 undergoing colonoscopy and 15 undergoing barium enema agreed to a semi-structured interview by a health psychologist. Interviews were recorded, responses transcribed and themes extracted with the aim of assimilating individual experiences to facilitate subsequent development and interpretation of quantitative surveys of overall satisfaction with each diagnostic test. Transcript analysis identified three principal themes: physical sensations, social interactions and information provision. Physical sensations differed for each test but were surprisingly well tolerated overall. Social interactions with staff were perceived as very important in colouring the whole experience, particularly in controlling the feelings of embarrassment, which was critical for all procedures. Information provision was also an important determinant of experience. Verbal feedback was most common during colonoscopy and invariably reassuring. However, patients undergoing CTC received little visual or verbal feedback and were often confused regarding the test outcome. Barium enema had no specific advantage over other tests. Qualitative interviews provided important perspectives on patient experience. Our data demonstrated that models describing the quality of medical encounters are applicable to single diagnostic episodes. Staff interactions and information provision were particularly important. We found advantages specific to both CTC and colonoscopy but none for barium enema. CTC could benefit greatly from improved information provision following examination.

Patient experiences of MR colonography and colonoscopy: a qualitative study

“…This supports the findings of prior CT colonography research [8] that patients are intrigued by the ability of modern scanners to image organs outside the large bowel. However, patients are often unaware that this may sometimes trigger subsequent tests to investigate unexpected findings.…”

“…Interview transcripts were analysed using standard thematic analysis [8] to assimilate individual patient experiences into broad descriptive groups of concerns and interests, therefore facilitating overall interpretation of the data. In particular, the data were coded by identifying recurrent themes related to patient perception of their experiences.…”

“…Such an approach prevents patients from describing expectations, experiences and preferences in their own words. For example, a recent qualitative investigation of patient experience of colonoscopy and CT colonography [8] revealed important differences in patient experience of staff interactions not previously considered by the authors, but which had important implications for the associated test anxiety.…”

Patient Acceptability and Psychologic Consequences of CT Colonography Compared with Those of Colonoscopy: Results from a Multicenter Randomized Controlled Trial of Symptomatic Patients

“…Prospective preference studies have investigated attitudes toward hypothetical referral rates (7), but, to our knowledge, there is no available evidence regarding patients' retrospective appraisals of follow-up investigations. Researchers have also highlighted important differences regarding result delivery; face-to-face delivery at the time of the procedure (colonoscopy) is perceived to be superior to communication later (CT colonography) (8). To our knowledge, this has not been assessed quantitatively.…”

Systematic Review and Meta-study Synthesis of Qualitative Studies Evaluating Facilitators and Barriers to Participation in Colorectal Cancer Screening

“…Screening for colorectal cancer can reduce the burden of the disease, yet participation in colorectal cancer screening is generally low (6,7) and tends to be lower among ethnic minorities (8)(9)(10)(11), individuals of low socioeconomic status (SES; refs. 8,[12][13][14], and may vary by gender (13)(14)(15)(16). It is important to understand why certain individuals get screened while others do not, the system and social factors affecting the decision to participate, and aspects of screening that are valued and culturally acceptable.…”