Radiology: Ouch! Colonoscopy discomfort leads patients to prefer CT colonography
CT colonography delivered superior patient acceptability compared with colonoscopy among symptomatic patients randomized to either exam; however, colonoscopy provided the benefit of more immediate delivery of results, according to a study published online March 21 in Radiology.
Previous studies comparing patient preferences of CT colonography and colonoscopy have been nonrandomized and have not assessed longer-term psychologic outcomes associated with the exams. Christian von Wagner, PhD, of the Health Behavior Research Centre at University College London, and colleagues aimed to fill the gap and devised a two-part questionnaire to compare patient attitudes immediately following and three months after the exams.
von Wagner et al leveraged a subset of patients enrolled in a multicenter randomized controlled trial comparing CT colonography and colonoscopy. The study population consisted of 547 patients with symptoms suggestive of colorectal cancer randomized 2:1 to colonoscopy and CT colonography.
“We found small but significant and consistent advantages favoring CT colonography, which was also associated with fewer posttest problems,” wrote the researchers.
The first step in the study consisted of an immediate posttest questionnaire to assess test experience and evaluate factors including worry, discomfort and adverse effects. A total of 258 colonoscopy patients and 130 CT colonography patients responded to the posttest questionnaire.
Although patient perceptions of bowel preparation were similar among both groups, the colonoscopy cohort expressed less satisfaction and more worry and discomfort than patients undergoing CT colonography. Median satisfaction scores were 61 for patients undergoing colonoscopy and 64 for those undergoing CT colonography. “Overall, physical discomfort was rated as significantly worse for patients undergoing colonoscopy (median score of 39 vs. 35),” wrote von Wagner and colleagues.
The CT colonography cohort also rated staff interactions more favorably than the colonoscopy group, a finding that surprised researchers as “previous qualitative study suggested that patients regard CT colonography as more impersonal than colonoscopy, with less interaction.”
A follow-up questionnaire was administered at three months, with 230 colonoscopy patients responding and 107 CT colonography patients responding. At this point, the differences between perceptions of the two exams attenuated and colonoscopy showed some advantages.
Sixty-five percent of colonoscopy patients received same-day results compared with 17 percent of CT colonography patients. In addition, the former were more likely to receive results face-to-face (85 vs. 50 percent).
A total of 37 percent of CT colonography patients underwent follow-up exams, significantly more than the 7 percent of colonoscopy patients who required follow-up exams, which confers a potential advantage to colonoscopy. “This would be especially important for patients at highest risk of harboring a tumor.”
von Wagner and colleagues concluded, “Findings from this randomized controlled trial suggest the immediate experience of CT colonography is more acceptable to patients than colonoscopy, but postprocedural differences in the way results are delivered favor colonoscopy… When making decisions to refer symptomatic patients, the clinical and administrative advantages of colonoscopy should be balanced against the superior acceptability of CT colonography.”
Previous studies comparing patient preferences of CT colonography and colonoscopy have been nonrandomized and have not assessed longer-term psychologic outcomes associated with the exams. Christian von Wagner, PhD, of the Health Behavior Research Centre at University College London, and colleagues aimed to fill the gap and devised a two-part questionnaire to compare patient attitudes immediately following and three months after the exams.
von Wagner et al leveraged a subset of patients enrolled in a multicenter randomized controlled trial comparing CT colonography and colonoscopy. The study population consisted of 547 patients with symptoms suggestive of colorectal cancer randomized 2:1 to colonoscopy and CT colonography.
“We found small but significant and consistent advantages favoring CT colonography, which was also associated with fewer posttest problems,” wrote the researchers.
The first step in the study consisted of an immediate posttest questionnaire to assess test experience and evaluate factors including worry, discomfort and adverse effects. A total of 258 colonoscopy patients and 130 CT colonography patients responded to the posttest questionnaire.
Although patient perceptions of bowel preparation were similar among both groups, the colonoscopy cohort expressed less satisfaction and more worry and discomfort than patients undergoing CT colonography. Median satisfaction scores were 61 for patients undergoing colonoscopy and 64 for those undergoing CT colonography. “Overall, physical discomfort was rated as significantly worse for patients undergoing colonoscopy (median score of 39 vs. 35),” wrote von Wagner and colleagues.
The CT colonography cohort also rated staff interactions more favorably than the colonoscopy group, a finding that surprised researchers as “previous qualitative study suggested that patients regard CT colonography as more impersonal than colonoscopy, with less interaction.”
A follow-up questionnaire was administered at three months, with 230 colonoscopy patients responding and 107 CT colonography patients responding. At this point, the differences between perceptions of the two exams attenuated and colonoscopy showed some advantages.
Sixty-five percent of colonoscopy patients received same-day results compared with 17 percent of CT colonography patients. In addition, the former were more likely to receive results face-to-face (85 vs. 50 percent).
A total of 37 percent of CT colonography patients underwent follow-up exams, significantly more than the 7 percent of colonoscopy patients who required follow-up exams, which confers a potential advantage to colonoscopy. “This would be especially important for patients at highest risk of harboring a tumor.”
von Wagner and colleagues concluded, “Findings from this randomized controlled trial suggest the immediate experience of CT colonography is more acceptable to patients than colonoscopy, but postprocedural differences in the way results are delivered favor colonoscopy… When making decisions to refer symptomatic patients, the clinical and administrative advantages of colonoscopy should be balanced against the superior acceptability of CT colonography.”