Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Nov 16, 2016; 8(19): 701-708
Published online Nov 16, 2016. doi: 10.4253/wjge.v8.i19.701
Information seeking and anxiety among colonoscopy-naïve adults: Direct-to-colonoscopy vs traditional consult-first pathways
Jocelyn A Silvester, Harmandeep Kalkat, Lesley A Graff, John R Walker, Harminder Singh, Donald R Duerksen
Jocelyn A Silvester, Harmandeep Kalkat, Lesley A Graff, John R Walker, Harminder Singh, Donald R Duerksen, Faculty of Health Sciences, College of Medicine, University of Manitoba, Winnipeg, MB R2H 2A6, Canada
Jocelyn A Silvester, Celiac Research Program, Boston Children’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States
Author contributions: Silvester JA and Kalkat H collected data; Silvester JA, Kalkat H, Graff LA, Walker JR, Singh H and Duerksen DR contributed to data analysis, editing of manuscript and approval of the final version as submitted; Silvester JA, Graff LA, Walker JR, Singh H and Duerksen DR conceived and designed the study.
Supported by Health Sciences Centre Medical Staff Council Resident Research Award.
Institutional review board statement: This study was reviewed and approved by the Research Ethics Board at the University of Manitoba.
Informed consent statement: All study participants were informed about the purpose of the study verbally and in writing. Submission of a completed survey constituted informed consent to participate in the study.
Conflict-of-interest statement: Harminder Singh has been a consultant to Pendopharm; the other authors have no conflicts of interest to declare.
Data sharing statement: No other data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Donald R Duerksen, MD, FRCPC, Associate Professor of Medicine, Faculty of Health Sciences, College of Medicine, University of Manitoba, St Boniface Hospital, C5120 - 409 Tache Avenue, Winnipeg, MB R2H 2A6, Canada. dduerkse@sbgh.mb.ca
Telephone: +1-204-2372796 Fax: +1-2042337154
Received: March 29, 2016
Peer-review started: April 4, 2016
First decision: May 23, 2016
Revised: July 7, 2016
Accepted: July 20, 2016
Article in press: July 22, 2016
Published online: November 16, 2016

To investigate the effects of direct to colonoscopy pathways on information seeking behaviors and anxiety among colonoscopy-naïve patients.


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.


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).


Procedure indication (cancer screening or symptom investigation) was more closely associated with information seeking behaviors and pre-procedure anxiety than care pathway.

Keywords: Direct access colonoscopy, Colonoscopy/utilization, Information seeking behavior, Referral and consultation, Health care delivery, Anxiety

Core tip: Direct access colonoscopy pathways are increasingly common, yet there has been relatively little scrutiny of how this practice impacts patients. This study examines the relationships among endoscopy pathway (direct vs traditional consult first), colonoscopy indication (cancer screening vs symptom investigation), information seeking behavior and pre-procedure anxiety. Patients undergoing their first colonoscopy completed questionnaires immediately prior to the procedure, before receiving sedation. The finding that direct-to-colonoscopy did not impact patient pre-procedure anxiety is reassuring. Analysis of information seeking behaviors underscores the crucial role of the family physician for referred patients who follow a direct-to-endoscopy pathway.