Patients' experience of using colonoscopy as a diagnostic test after a positive FOBT/FIT: a systematic review of the quantitative literature.

Abstract

Objectives: Faecal occult blood testing (FOBT) and faecal immunochemical testing (FIT) are among the most used screening modalities for colorectal cancer (CRC). Colonoscopy is also widely used as a screening and diagnostic test for adults with a positive FOBT/FIT. Patient experience of colonoscopy is an important component for most CRC screening programmes. Individuals with negative experiences are less likely to engage with colonoscopy in the future and can deter others from attending colonoscopy when invited. This review synthesised data on patient experience with colonoscopy, following a positive result, to provide insights into how to improve patient experience within the English Bowel Cancer Screening Programme.
Methods: MEDLINE, EMBASE and PsychInfo were searched for quantitative questionnaire studies evaluating patient-reported experience with colonoscopy, following a positive screening FOB/FIT result. The search was limited to studies published between 2000-2021 (i.e. when the first FOBT/FIT screening programmes for CRC were introduced). Data-driven and narrative summary techniques were used to summarise the literature.
Results: In total, six studies from the United Kingdom (n=4), Spain (n=1) and the Netherlands (n=1) were included in the review (total participants: 152,329; response rate: 68.0-79.3%). Patient experiences were categorised into three ‘stages’: ‘pre-colonoscopy’, ‘during the test’, and ‘post-colonoscopy’. Overall, patients reported a positive experience in all six studies. Bowel preparation was the most frequently endorsed issue experienced pre-test (experienced by 10.0% to 41.0% of individuals, across all studies), pain and discomfort for during the test (experienced by 10.0% to 21.0% of participants) and abdominal pain and discomfort after the test (these were experienced by 14.8%-22% of patients).
Conclusion: This review highlighted that patient-reported experiences associated with colonoscopy were generally positive. To improve the colonoscopy experience, bowel screening centres should investigate means to: make bowel preparation more acceptable, make colonoscopy less painful, and reduce post-colonoscopy symptoms.