Prospective study of anxiety in patients undergoing an outpatient colonoscopy

Abstract

Background: Undergoing a colonoscopy can cause anxiety in patients and this is something which has not been closely studied.Objective: To determine the frequency and intensity of anxiety prior to a colonoscopy and the factors which are related to the procedure.Methods: This is a prospective study of patients undergoing outpatient colonoscopy in our hospital. Anxiety was assessed using a visual analogue scale of 0 to 100. The severity of anxiety was rated as mild (1-29), moderate (30-79) or severe (80-100).Results: Three hundred and twenty-seven patients completed the study, of whom 154 (47.1%) were men with a median age of 54 years (p25-75: 45-65). Three hundred and nine (94.5%) patients were found to suffer a certain degree of anxiety. The median value on the visual analogue scale was 31 (p25-75: 10-53). Anxiety levels were mild in 136 patients (44%), moderate in 141 (45.6%) and severe in 32 (10.4%). Greater anxiety was associated with female patients (mean 40.38 vs 31.99, p = 0.01) and a poorly tolerated previous colonoscopy (mean 50.67 vs 28.44, p = 0.01) and correlated inversely with age (r = -0.170, p = 0.02).Conclusions: Colonoscopy causes some degree of anxiety in most patients. Being female, younger and having experienced poor tolerance to a previous scan are associated with greater degrees of anxiety. These findings should be taken into account in the implementation of measures to improve the quality and tolerance of colonoscopy.

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“…There are two separate possible explanations for this: first, respondents in the screened population had already experienced a consultation where they had received information about colonoscopies. This might have lowered their level of anxiety in relation to the procedure, and adjusted their (possibly unrealistic) expectations about the preventive capability this procedure has (ie, the misconception that more frequent colonoscopies reduces the risk of developing CRC) 18,35,36. Second, if the possibility of one’s own death becomes probable and realistic, people tend to focus on this fact, disregarding other factors (ie, death priming) 16,37–39.…”

Prospective study of the factors associated with poor tolerance to ambulatory colonoscopy under conscious sedation

“…These findings are consistent with previous research. Causes of pre-colonoscopy anxiety include the waiting time prior to the procedure, fear of pain, possible diagnosis, suffering a complication, embarrassment, or the need to repeat the procedure due to poor preparation (13)(14)(15)19,26,28).…”

“…Others have associated poor tolerance with aspects related to both the exploration and the diagnostic procedure itself, including the reason for the procedure as well as the duration and difficulty of the colonoscopy. However, the methodology used in these studies varies considerably since many of them analyze oral endoscopy and colonoscopy together, whilst others include unsedated patients or assess tolerance through indirect methods such as the use of higher doses of sedatives (11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Furthermore, no studies with these characteristics have been found in our context.…”

Gender, having a positive FIT and type of hospital are important factors for colonoscopy experience in colorectal cancer screening – findings from the SCREESCO study

“…The explanatory value of the ten regression analyses is relatively low, although the regression analysis for 'worry before the examination' (Q4), 'discomfort during colonoscopy' (Q5), 'pain during colonoscopy' (Q6) and 'worry about the result' (Q7) may explain some of the variance of outcome variable better than the other regression analyses. This means that additional factors not captured in our questionnaire may be important for the colonoscopy experience, for example, the bowel preparation [13,31], patients' expectations, the ability to choose appointment and/or examination methods, embarrassment [15,31], environmental factors at the endoscopy unit as well as factors related to the endoscopist [13] and endoscopy assistant [19]. The generalizability to other age groups may not be relevant since all participants were 60 years, although the age range is not that wide in CRC screening.…”

“…However, choosing gender of the endoscopist was not considered important in a qualitative study by Nielsen et al [15], but still, individuals, especially men reported that they felt more embarrassed when the endoscopist was of the opposite gender. Gender is a further important factor for the colonoscopy experience, as women feel more vulnerable [17] and more anxious and [19] report more discomfort and pain [12] compared to men. Women also report higher levels of anxiety related to their screening decision [20], which may impact the colonoscopy experience.…”