Screening individuals’ experiences of colonoscopy and colon capsule endoscopy; a mixed methods study

Abstract

Background: The standard investigation in colorectal cancer screening (optical colonoscopy [OC]) has a less invasive alternative with the colon capsule endoscopy (CCE). The experiences of screening individuals are needed to support a decision aid (DA) and to provide a patient view in future health technology assessments (HTA). We aimed to explore the experiences of CCE at home and OC in an outpatient clinic by screening participants who experienced both investigations on the same bowel preparation. Methods: In a mixed methods study, Danish screening individuals with a positive immunological fecal occult blood test (FIT) were consecutively included and underwent both CCE and OC in the same bowel preparation. They answered questionnaires about discomfort during CCE, delivered at home, and during a following OC in the outpatient clinic. Data were calculated in percentages and Wilcoxon signed rank test was used for comparisons. Among the 253 included patients, 10 participants were selected for a semi-structured interview about their experiences of the two examinations. The analysis and interpretation of the transcribed data were inspired by Ricoeur. Results: Questionnaire data were received from 239 participants and revealed significant less discomfort during the CCE than the OC. Interview data included explained discomfort elements in two categories: 'The examination' and 'The setting'. Compared to OC, the CCE was experienced with less pain, embarrassment and invasiveness, but presented challenges and disadvantages as well, i.e., a large camera capsule to swallow, a longer waiting time for test results after CCE and an additional OC, if pathologies were found. The home setting for CCE delivery made the participants feel less like they were ill or patients less restricted and that they received more personal care, but could induce technical challenges. MethodsA mixed methods design was chosen in order to obtain as comprehensive knowledge as possible. Within a cohort study

Diagnostic accuracy of capsule endoscopy compared with colonoscopy for polyp detection: systematic review and meta-analyses

“…Surprisingly, they also observed that only 85.7 % of the CCE patients were willing to undergo the same test again, compared with 93.6 % and 96.1 % for colonoscopy and CT-colonography patients, respectively. We investigated this in a previous publication and found support for this statement [4]. In addition to acceptability, logistics is another concern.…”

Patient experience of gastrointestinal endoscopy: informing the development of the Newcastle ENDOPREM™

“…This is the first time that patient perspectives across three GI procedures have been explored using in-depth, qualitative methods. While some qualitative literature exists, this tends to focus on specific populations (eg, Barrett’s oesophagus surveillance, colorectal cancer screening25 26) or specific aspects of experience (eg, comfort during colonoscopy versus colon capsule endoscopy26 27). Furthermore, where more than one modality has been explored findings have been analysed and described separately 26.…”

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