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Factors Associated with Anxiety About Colonoscopy: The Preparation, the Procedure, and the Anticipated Findings

Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Previous research has assessed anxiety around colonoscopy procedures, but has not considered anxiety related to different aspects related to the colonoscopy process.

Aims

Before colonoscopy, we assessed anxiety about: bowel preparation, the procedure, and the anticipated results. We evaluated associations between patient characteristics and anxiety in each area.

Methods

An anonymous survey was distributed to patients immediately prior to their outpatient colonoscopy in six hospitals and two ambulatory care centers in Winnipeg, Canada. Anxiety was assessed using a visual analog scale. For each aspect, logistic regression models were used to explore associations between patient characteristics and high anxiety.

Results

A total of 1316 respondents completed the questions about anxiety (52% female, median age 56 years). Anxiety scores > 70 (high anxiety) were reported by 18% about bowel preparation, 29% about the procedure, and 28% about the procedure results. High anxiety about bowel preparation was associated with female sex, perceived unclear instructions, unfinished laxative, and no previous colonoscopies. High anxiety about the procedure was associated with female sex, no previous colonoscopies, and confusing instructions. High anxiety about the results was associated with symptoms as an indication for colonoscopy and instructions perceived as confusing.

Conclusions

Fewer people had high anxiety about preparation than about the procedure and findings of the procedure. There are unique predictors of anxiety about each colonoscopy aspect. Understanding the nuanced differences in aspects of anxiety may help to design strategies to reduce anxiety, leading to improved acceptance of the procedure, compliance with preparation instructions, and less discomfort with the procedure.

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References

  1. Singh H, Demers AA, Xue L, Turner D, Bernstein CN. Time trends in colon cancer incidence and distribution and lower gastrointestinal endoscopy utilization in Manitoba. Am J Gastroenterol. 2008;103:1249–1256.

    Article  PubMed  Google Scholar 

  2. Lieberman D. How good is your dentist? How good is your endoscopist? The quality imperative. Gastroenterology. 2012;142:194–196.

    Article  PubMed  Google Scholar 

  3. Lang EV, Hatsiopoulou O, Koch T, et al. Can words hurt? Patient–provider interactions during invasive procedures. Pain. 2005;114:303–309.

    Article  PubMed  Google Scholar 

  4. Saadat H, Drummond-Lewis J, Maranets I, et al. Hypnosis reduces preoperative anxiety in adult patients. Anesth Analg. 2006;102:1394–1396.

    Article  PubMed  Google Scholar 

  5. Caumo W, Schmidt AP, Schneider CN, et al. Risk factors for preoperative anxiety in adults. Acta Anaesth Scand. 2001;45:298–307.

    Article  CAS  PubMed  Google Scholar 

  6. Moline LR. Patient psychologic preparation for invasive procedures: an integrative review. J Vasc Nurs. 2000;18:117–122.

    Article  CAS  PubMed  Google Scholar 

  7. Furer P, Walker JR, Stein MB. Treating health anxiety and fear of death: a practitioner’s guide. Berlin: Springer; 2007.

    Google Scholar 

  8. Parker J, Kennedy P. Factors predictive of distress in people awaiting a lower gastro-intestinal endoscopy. Psychol Health Med. 2010;15:26–33.

    Article  PubMed  Google Scholar 

  9. Tam WW, Wong EL, Twinn SF. Effect of music on procedure time and sedation during colonoscopy: a meta-analysis. W J Gastroenterol. 2008;14:5336.

    Article  Google Scholar 

  10. Arikan S. Assessment of anxiety levels in patients during elective upper gastrointestinal endoscopy and colonoscopy. Turk J Gastroenterol. 2010;21:29–33.

    PubMed  Google Scholar 

  11. Jones MP, Ebert CC, Sloan T, et al. Patient anxiety and elective gastrointestinal endoscopy. J Clin Gastroenterol. 2004;38:35–40.

    Article  PubMed  Google Scholar 

  12. Carter XW, Topolski R, Hatzigeorgiou C, Fincher RK. Role of anxiety in the comfort of nonsedated average-risk screening sigmoidoscopy. South Med J. 2013;106:280–284.

    Article  PubMed  Google Scholar 

  13. Kutlutürkan S, Görgülü Ü, Fesci H, Karavelioglu A. The effects of providing pre-gastrointestinal endoscopy written educational material on patients’ anxiety: a randomised controlled trial. Int J Nurs Stud. 2010;47:1066–1073.

    Article  PubMed  Google Scholar 

  14. Rollbusch N, Mikocka-Walus AA, Andrews JM. The experience of anxiety in colonoscopy outpatients: a mixed-method study. Gastroenterol Nurs. 2014;37:166–175.

    Article  PubMed  Google Scholar 

  15. van Vliet MJ, Grypdonck M, van Zuuren FJ, Winnubst J, Kruitwagen C. Preparing patients for gastrointestinal endoscopy: the influence of information in medical situations. Patient Educ Couns. 2004;52:23–30.

    Article  PubMed  Google Scholar 

  16. Bytzer P, Lindeberg B. Impact of an information video before colonoscopy on patient satisfaction and anxiety-a randomized trial. Endoscopy. 2007;39:710–714.

    Article  CAS  PubMed  Google Scholar 

  17. Coombes JM, Steiner JF, Bekelman DB, Prochazka AV, Denberg TD. Clinical outcomes associated with attempts to educate patients about lower endoscopy: a narrative review. J Community Health. 2008;33:149–157.

    Article  PubMed  Google Scholar 

  18. Takahashi Y, Tanaka H, Kinjo M, Sakumoto K. Prospective evaluation of factors predicting difficulty and pain during sedation-free colonoscopy. Dis Colon Rectum. 2005;48:1295–1300.

    Article  PubMed  Google Scholar 

  19. Chung Y, Han D, Yoo K-S, Park C. Patient factors predictive of pain and difficulty during sedation-free colonoscopy: a prospective study in Korea. Dig Liver Dis. 2007;39:872–876.

    Article  CAS  PubMed  Google Scholar 

  20. Ylinen ER, Vehviläinen-Julkunen K, Pietilä AM. Effects of patients’ anxiety, previous pain experience and non-drug interventions on the pain experience during colonoscopy. J Clin Nurs. 2009;18:1937–1944.

    Article  PubMed  Google Scholar 

  21. Morgan J, Roufeil L, Kaushik S, Bassett M. Influence of coping style and precolonoscopy information on pain and anxiety of colonoscopy. Gastrointest Endosc. 1998;48:119–127.

    Article  CAS  PubMed  Google Scholar 

  22. Shafer LA, Waldman C, Michaud V, et al. Predictors of patient reluctance to use split dose bowel preparation for early morning colonoscopies. Gastroenterology. 2017;152:S851.

    Article  Google Scholar 

  23. Voiosu A, Tantau A, Garbulet C. Factors affecting colonoscopy comfort and compliance: a questionnaire based multicenter study. Rom J Int Med. 2014;52:151–157.

    CAS  Google Scholar 

  24. Sharara AI, Mrad RRA. The modern bowel preparation in colonoscopy. Gastroenterol Clin N Am. 2013;42:577–598.

    Article  Google Scholar 

  25. Rex DK. Optimal bowel preparation-a practical guide for clinicians. Nat Rev Gastroenterol Hepatol. 2014;11:419–425.

    Article  PubMed  Google Scholar 

  26. Lebwohl B, Kastrinos F, Glick M, Rosenbaum AJ, Wang T, Neugut AI. The impact of suboptimal bowel preparation on adenoma miss rates and the factors associated with early repeat colonoscopy. Gastrointest Endosc. 2011;73:1207–1214.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Saltzman JR, Cash BD, Pasha SF, et al. Bowel preparation before colonoscopy. Gastrointest Endosc. 2015;81:781–794.

    Article  PubMed  Google Scholar 

  28. Johnson DA, Barkun AN, Cohen LB, et al. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer. Am J Gastroenterol. 2014;109:1528.

    Article  PubMed  Google Scholar 

  29. Facco E, Zanette G, Favero L, et al. Toward the validation of visual analogue scale for anxiety. Anesth Progress. 2011;58:8–13.

    Article  CAS  Google Scholar 

  30. Facco E, Stellini E, Bacci C, et al. Validation of visual analogue scale for anxiety (VAS-A) in preanesthesia evaluation. Minerva Anestesiol. 2013;79:1389–1395.

    CAS  PubMed  Google Scholar 

  31. Cowley JA, Youngblood H. Subjective response differences between visual analogue, ordinal and hybrid response scales, In Proceedings of the Human Factors and Ergonomics Society Annual Meeting. Los Angeles, CA, Sage Publications Sage CA; 2009.

  32. Grilo BI, Herrera MP, Aguado ÁM. Prospective study of anxiety in patients undergoing an outpatient colonoscopy. Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva. 2016;108:765–769.

    Google Scholar 

  33. Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain. 1983;16:87–101.

    Article  CAS  PubMed  Google Scholar 

  34. Folstein MF, Luria R. Reliability, validity, and clinical application of the Visual Analogue Mood Scale. Psychol Med. 1973;3:479–486.

    Article  CAS  PubMed  Google Scholar 

  35. Carroll JB. The nature of the data, or how to choose a correlation coefficient. Psychometrika. 1961;26:347–372.

    Article  Google Scholar 

  36. Bonett DG, Price RM. Inferential methods for the tetrachoric correlation coefficient. J Educ Behav Stat. 2005;30:213–225.

    Article  Google Scholar 

  37. Pigott TA. Gender differences in the epidemiology and treatment of anxiety disorders. J Clin Psychiatry. 1999;60:4–15.

    Article  PubMed  Google Scholar 

  38. Kim KA, Moser DK, Garvin BJ, Riegel BJ. Differences between men and women in anxiety early after acute myocardial infarction. Am J Crit Care. 2000;9:245.

    CAS  PubMed  Google Scholar 

  39. Mikocka-Walus AA, Moulds LG, Rollbusch N, Andrews JM. “It’s a tube up your bottom; it makes people nervous”: the experience of anxiety in initial colonoscopy patients. Gastroenterol Nurs. 2012;35:392–401.

    Article  PubMed  Google Scholar 

  40. Shaikh AA, Hussain SM, Rahn S, Desilets DJ. Effect of an educational pamphlet on colon cancer screening: a randomized, prospective trial. Eur J Gastroenterol Hepatol. 2010;22:444–449.

    Article  PubMed  Google Scholar 

  41. Arabul M, Kandemır A, Çelık M, et al. Impact of an information video before colonoscopy on patient satisfaction and anxiety. Turk J Gastroenterol Off J Turk Soc Gastroenterol. 2011;23:523–529.

    Google Scholar 

  42. Hsueh F-C, Chen C-M, Sun C-A, Chou Y-C, Hsiao S-M, Yang T. A study on the effects of a health education intervention on anxiety and pain during colonoscopy procedures. J Nurs Res. 2016;24:181–189.

    Article  PubMed  Google Scholar 

  43. Björkman I, Karlsson F, Lundberg A, Frisman GH. Gender differences when using sedative music during colonoscopy. Gastroenterol Nurs. 2013;36:14–20.

    Article  PubMed  Google Scholar 

  44. Umezawa S, Higurashi T, Uchiyama S, et al. Visual distraction alone for the improvement of colonoscopy-related pain and satisfaction. W J Gastroenterol. 2015;21:4707.

    Article  Google Scholar 

  45. Xiaolian J, Xiaolin L, Lan ZH. Effects of visual and audiovisual distraction on pain and anxiety among patients undergoing colonoscopy. Gastroenterol Nurs. 2015;38:55–61.

    Article  PubMed  Google Scholar 

  46. Cai S-R, Zhang S-Z, Zhu H-H, Zheng S. Barriers to colorectal cancer screening: a case-control study. W J Gastroenterol. 2009;15:2531.

    Article  Google Scholar 

  47. Bhise V, Modi V, Kalavar A, et al. Patient-reported attributions for missed colonoscopy appointments in two large healthcare systems. Dig Dis Sci. 2016;61:1853–1861. https://doi.org/10.1007/s10620-016-4096-3.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was funded by an operating research grant from Research Manitoba. The funding agency had no role in the conduct of the study or the reporting of the findings. Ms. Celeste Waldman died during the duration of the study; she was involved in the development of the study, leading the conduct of the study and the first set of analysis. All other authors were involved in the analysis and interpretation of data and critical revision of the manuscript for important intellectual content. Drs. Walker, Sisler, Park, Bernstein, Restall, Wittmeier, and Singh were involved in the study concept and design. Dr. Shafer performed the analysis and wrote the first draft. Dr. Bernstein is supported in part by the Bingham Chair in Gastroenterology. Dr. Singh has been on advisory board of Pendopharm and Ferring and has received research funding from Merck Canada. Dr. Bernstein has served on advisory boards for Abbvie Canada, Ferring Canada, Janssen Canada, Shire Canada, Pfizer Canada, and Takeda Canada. He has consulted to Mylan Pharmaceuticals and Bristol Myers Squibb. He has received unrestricted educational grants from Abbvie Canada, Janssen Canada, Shire Canada, and Takeda Canada. He has been on speaker’s bureau for Abbvie Canada, Ferring Canada, and Shire Canada.

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Correspondence to H. Singh.

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Shafer, L.A., Walker, J.R., Waldman, C. et al. Factors Associated with Anxiety About Colonoscopy: The Preparation, the Procedure, and the Anticipated Findings. Dig Dis Sci 63, 610–618 (2018). https://doi.org/10.1007/s10620-018-4912-z

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  • DOI: https://doi.org/10.1007/s10620-018-4912-z

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