June 26, 2017
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Fear, anxiety before colonoscopy negatively impact patient experience

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Many patients experience fear and anxiety before undergoing colonoscopy, and at high levels, these emotions may produce a negative patient experience, according to new research presented at the American Society of Colon and Rectal Surgeons Annual Scientific Meeting.

In particular, such patients could require higher levels of sedation or have lower tolerance of the procedure, according to James M. Church, MD, of the department of colorectal surgery at the Cleveland Clinic.

James M. Church, MD

James M. Church

“A lot of people are afraid of colonoscopies but very few studies have documented the reasons why,” he told Healio Gastroenterology.Colonoscopy screening is the best way to prevent colorectal cancer but people often do not make use of the test because they are afraid of it. This study documents why they are afraid, which should go a long way to helping caregivers relieve anxiety and allay fears.”

Church and colleagues asked 119 consecutive patients undergoing elective outpatient colonoscopy to complete a questionnaire on their fear, anxiety and procedural experience before and after the procedure. Overall, 65 of the participants were men, the average age was 66 years, and for 11 of the participants this was their first colonoscopy.

Regression analysis revealed a significant relationship between fear and anxiety (P < .0001).

Few patients reported high levels of fear and anxiety, defined as ratings of 7 or higher on a 10-point scale, but those who did report high levels of fear also reported they experienced significantly more pain (4.7 vs. 2.7 on a 10-point scale; P = .0065), while the difference in pain scores was not significant among those who reported high levels of anxiety (4.1 vs. 2.8; P = .1515). In addition, anxiety levels did not affect a patient’s willingness to have another colonoscopy.

Patients reported that the reasons for their fear included what might be found during the procedure, and issues related to sedation and pain. Their reasons for anxiety included what might be found during the procedure, having previously had a negative colonoscopy experience, the possibility of a mistake or complication, and issues related to sedation.

Church acknowledged that most of the study participants had a previous colonoscopy, and their experience with the procedure may be a study limitation. Despite this, he concluded that the study shows patients do experience fear and anxiety, which can affect their experience of the procedure at high levels.

“Colonoscopists should be alert to the mental state of the patients they examine,” he wrote in the abstract. – by Adam Leitenberger

Reference:

Church J. Abstract P465. Presented at: American Society of Colon and Rectal Surgeons Annual Scientific Meeting; June 10-14, 2017; Seattle.

Disclosures: The researchers report no relevant financial disclosures.