Clinician-reported Gloucester Comfort Scale scores underestimate patient discomfort and pain during colonoscopy: insights from comparison with a patient-reported experience measure

Abstract

Background

Patient experience is a fundamental element of colonoscopy. The Gloucester Comfort Scale (GCS) is used by clinicians to report patient comfort. However, insights regarding the extent to which clinician-reported GCS scores represent the patient’s experience are lacking. We assessed the level of agreement between clinician-reported GCS scores and patient-reported discomfort and pain.

Methods

Consecutive patients undergoing colonoscopy at two Dutch endoscopy clinics were included. Patient comfort during colonoscopy was reported using the GCS (1–5 scale). Patients’ colonoscopy experiences were assessed using the Newcastle ENDOPREM, a validated endoscopy patient-reported experience measure (PREM). Patients reported both discomfort and pain levels experienced during colonoscopy on a 1–5 scale. Levels of agreement were assessed using Cohen’s kappa statistic.

Results

For 243 included patients, the GCS score was higher than the PREM discomfort score in 52 patients (21%) and lower in 72 (30%). GCS score was higher than the PREM pain score in 39 patients (16%) and lower in 71 (29%). Moderate-to-severe discomfort and pain (scores ≥3) were reported by 53 patients (22%) for discomfort and 60 patients (25%) for pain. For these patients, the GCS underestimated discomfort and pain levels in almost all cases (discomfort 49/53 [92%], pain 54/60 [90%]). Agreement between GCS scores and PREM discomfort and pain scores were minimal (Cohen’s κ 0.34) and weak (Cohen’s κ 0.47), respectively.

Conclusions

Clinician-reported GCS scores frequently underestimated the level of discomfort and pain reported by patients. For accurate monitoring of patients’ colonoscopy experiences, the use of PREMs should be considered.

Publikationsverlauf

Eingereicht: 17. September 2024

Angenommen nach Revision: 26. Januar 2025

Accepted Manuscript online:
29. Januar 2025

Artikel online veröffentlicht:
28. Februar 2025

• References

• 1 Pylvänäinen K, Kairaluoma M, Mecklin JP. Compliance and satisfaction with long-term surveillance in Finnish HNPCC families. Fam Cancer 2006; 5: 175-178
• 2 Ko HH, Zhang H, Telford JJ. et al. Factors influencing patient satisfaction when undergoing endoscopic procedures. Gastrointest Endosc 2009; 69: 883-891
• 3 Sint Nicolaas J, de Jonge V, Korfage IJ. et al. Benchmarking patient experiences in colonoscopy using the Global Rating Scale. Endoscopy 2012; 44: 462-472
• 4 Baudet JS, Aguirre-Jaime A. The sedation increases the acceptance of repeat colonoscopies. Eur J Gastroenterol Hepatol 2012; 24: 775-780
• 5 Rex DK, Schoenfeld PS, Cohen J. et al. Quality indicators for colonoscopy. Gastrointest Endosc 2015; 81: 31-53
• 6 Rees CJ, Thomas Gibson S, Rutter MD. et al. UK key performance indicators and quality assurance standards for colonoscopy. Gut 2016; 65: 1923-1929
• 7 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397
• 8 Ekkelenkamp VE, Dowler K, Valori RM. et al. Patient comfort and quality in colonoscopy. World J Gastroenterol 2013; 19: 2355-2361
• 9 Ojidu H, Palmer H, Lewandowski J. et al. Patient tolerance and acceptance of different colonic imaging modalities: an observational cohort study. Eur J Gastroenterol Hepatol 2018; 30: 520-525
• 10 Telford J, Tavakoli I, Takach O. et al. Validation of the St. Paul’s Endoscopy Comfort Scale (SPECS) for colonoscopy. J Can Assoc Gastroenterol 2020; 3: 91-95
• 11 Neilson LJ, Patterson J, von Wagner C. et al. Patient experience of gastrointestinal endoscopy: informing the development of the Newcastle ENDOPREM. Frontline Gastroenterol 2020; 11: 209-217
• 12 Neilson LJ, Sharp L, Patterson JM. et al. The Newcastle ENDOPREM: a validated patient reported experience measure for gastrointestinal endoscopy. BMJ Open Gastroenterol 2021; 8: e000653
• 13 Lee JK, Lee YJ, Cho JH. et al. Updates on the sedation for gastrointestinal endoscopy. Clin Endosc 2019; 52: 451-457
• 14 Denters MJ, Schreuder M, Depla AC. et al. Patients’ perception of colonoscopy: patients with inflammatory bowel disease and irritable bowel syndrome experience the largest burden. Eur J Gastroenterol Hepatol 2013; 25: 964-972
• 15 Nass KJ, van Doorn SC, Fockens P. et al. High quality colonoscopy: using textbook process as a composite quality measure. Endoscopy 2023; 55: 812-819
• 16 Fuccio L, Rees CJ, Frazzoni L. et al. Patient-reported experience of colonoscopy in Italy: a multicentre prospective observational study. Gut 2023; 72: 2227-2230
• 17 McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb) 2012; 22: 276-282
• 18 Rea LM, Parker RA. Designing and conducting survey research: a comprehensive guide. San Francisco, California: Jossey-Bass; 1997
• 19 Elphick DA, Donnelly MT, Smith KS. et al. Factors associated with abdominal discomfort during colonoscopy: a prospective analysis. Eur J Gastroenterol Hepatol 2009; 21: 1076-1082
• 20 Seip B, Bretthauer M, Dahler S. et al. Patient satisfaction with on-demand sedation for outpatient colonoscopy. Endoscopy 2010; 42: 639-646
• 21 Holme O, Bretthauer M, de Lange T. et al. Risk stratification to predict pain during unsedated colonoscopy: results of a multicenter cohort study. Endoscopy 2013; 45: 691-696
• 22 Bugajski M, Wieszczy P, Hoff G. et al. Modifiable factors associated with patient-reported pain during and after screening colonoscopy. Gut 2018; 67: 1958-1964
• 23 Peduzzi P, Concato J, Kemper E. et al. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996; 49: 1373-1379
• 24 Ramakrishnan S, Yiannakou JY, Ellis WR. et al. Assessment of patient pain at colonoscopy: are nurses better than endoscopists?. J R Soc Med 2004; 97: 432-433
• 25 Rostom A, Ross ED, Dube C. et al. Development and validation of a nurse-assessed patient comfort score for colonoscopy. Gastrointest Endosc 2013; 77: 255-261
• 26 Naumann DN, Potter-Concannon S, Karandikar S. Interobserver variability in comfort scores for screening colonoscopy. Frontline Gastroenterol 2019; 10: 372-378
• 27 Ryhlander J, Ringstrom G, Lindkvist B. et al. Risk factors for underestimation of patient pain in outpatient colonoscopy. Scand J Gastroenterol 2022; 57: 1120-1130
• 28 Heuss LT, Sughanda SP, Degen LP. Endoscopy teams’ judgment of discomfort among patients undergoing colonoscopy: “How bad was it really?”. Swiss Med Wkly 2012; 142: w13726
• 29 Shah SG, Brooker JC, Williams CB. et al. Effect of magnetic endoscope imaging on colonoscopy performance: a randomised controlled trial. Lancet 2000; 356: 1718-1722
• 30 Hoff G, Bretthauer M, Dahler S. et al. Improvement in caecal intubation rate and pain reduction by using 3-dimensional magnetic imaging for unsedated colonoscopy: a randomized trial of patients referred for colonoscopy. Scand J Gastroenterol 2007; 42: 885-889
• 31 Paggi S, Radaelli F, Amato A. et al. Unsedated colonoscopy: an option for some but not for all. Gastrointest Endosc 2012; 75: 392-398
• 32 Voiosu A, Tanţău A, Garbulet C. et al. Factors affecting colonoscopy comfort and compliance: a questionnaire based multicenter study. Rom J Intern Med 2014; 52: 151-157
• 33 Luck A, Pearson S, Maddern G. et al. Effects of video information on precolonoscopy anxiety and knowledge: a randomised trial. Lancet 1999; 354: 2032-2035
• 34 Hsueh FC, Chen CM, Sun CA. et al. A study on the effects of a health education intervention on anxiety and pain during colonoscopy procedures. J Nurs Res 2016; 24: 181-189
• 35 Ball AJ, Rees CJ, Corfe BM. et al. Sedation practice and comfort during colonoscopy: lessons learnt from a national screening programme. Eur J Gastroenterol Hepatol 2015; 27: 741-746
• 36 Glenwright BG, Simmich J, Cottrell M. et al. Facilitators and barriers to implementing electronic patient-reported outcome and experience measures in a health care setting: a systematic review. J Patient Rep Outcomes 2023; 7: 13
• 37 Mazor KM, Clauser BE, Field T. et al. A demonstration of the impact of response bias on the results of patient satisfaction surveys. Health Serv Res 2002; 37: 1403-1417