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

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 experience was 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 discomfort score in 52 (21%) patients, and lower in 72 (30%). GCS score was higher than the pain score in 39 (16%) patients, and lower in 71 (29%). Moderate to severe discomfort and pain (scores >3) were reported by 53 (22%) patients for discomfort and 60 (25%) patients for pain. For these patients, the GCS underestimated discomfort and pain levels in almost all cases (discomfort: 49/53 [92%], pain: 54/60 [90%]). The levels of agreement between GCS scores and 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 underestimate the level of discomfort and pain as reported by patients. For accurate monitoring of patients’ colonoscopy experience, the use of PREMs should be considered.

Publication History

Received: 17 September 2024

Accepted after revision: 26 January 2025

Accepted Manuscript online:
29 January 2025