Patients' experience of colonoscopy in the English Bowel Cancer Screening Programme

Background and study aims: Understanding patients' experience of screening programs is crucial for service improvement. The English Bowel Cancer Screening Programme (BCSP) aims to achieve this by sending out questionnaires to all patients who undergo a colonoscopy following an abnormal fecal occult blood test result. This study used the questionnaire data to report the experiences of these patients. Patients and methods: Data on patients who underwent colonoscopy between 2011 and 2012 were extracted from the BCSP database. Descriptive statistics were used to summarize key questionnaire items relating to informed choice, psychological wellbeing, physical experience, and after-effects. Multilevel logistic regression was used to test for associations with variables of interest: sex, age, socioeconomic status, colonoscopy results, and screening center performance (adenoma detection rate, cecal intubation rate, proportion of colonoscopies involving sedation). Results: Data from 50 858 patients (79.3% of those eligible) were analyzed. A majority reported a positive experience on items relating to informed choice (e.g. 95.7% felt they understood the risks) and psychological wellbeing (e.g. 98.3% felt they were treated with respect). However, an appreciable proportion experienced unexpected test discomfort (21.0 %) or pain at home (14.8 %). There were few notable demographic differences, although women were more likely than men to experience unexpected discomfort (25.1% vs. 18.0 %; P < 0.01) and pain at home (18.2% vs. 12.3 %; P < 0.01). No associations with center-level variables were apparent. Conclusions: Colonoscopy experience was generally positive, suggesting high satisfaction with the BCSP. Reported pain and unexpected discomfort were more negative than most other outcomes (particularly for women); measures to improve this should be considered.