Published online Nov 16, 2016. doi: 10.4253/wjge.v8.i19.701
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.
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.