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Projektplan Patient satisfaction (Pain (Risk factors to experience pain…
Projektplan Patient satisfaction
Pain
Abdominal
Procedure
3/4 experienced mild pain or no pain
Ylinen et al. 2009
Women more painful then men
Bytzer & Lindeberg 2007
Ylinen et al 2009
Women tended to report "no pain" less often than men, 69% versus 80%
Larsen et al 2002
Free text comments that they had experienced more pain than expected
Highlights that pain management might not be adequate, particulary during conscious sedation
Rollbusch et al 2014
Due to sedation less the 3 on a VAS scale
Nicholson & Korman 2005
Considered to be visceral pain during colonoscopy
Autonomous and motor components (hypotension and nausea)
Sensor afferent nerves
Poorly localised, diffuse and frequently referred to other intact tissues and it is of concern because it seems to be resistant to current treatments
Ylinen et al 2009
Patient who experienced colonoscopy (or lower endoscopic procedures) were particularly uncomfortable. Making comment about pain (sharp, very painful, stomach pain).
Sincock et al 1999
After
Flatus
Diarrhoea
Scales
VAS
VRS
CBNPS
Patients previous experience
Nurses knowledge and skills in pain management
Numerous non-pharmacological methods
Lack of pain scales
Lack of ethical conversation
Ylinen et al. 2007
Nurses and endoscopists underestimated patient experienced pain
Ylinen et al. 2009
Bytzer & Lindeberg 2007
Risk factors to experience pain
Nervousness
Ylinen et al. 2009
Gender
Age
Pelvis operation
BMI
First time colonoscopy
Diarrhoea
Pain control - Ranked as number 1 by 16% of patients
Yacavone et al 2001
Females tend to have an inherently longer colon which may predispose the colonoscope to painful looping
Ylinen et al 2009
Less satisfied with pain experienced during the procedure in a follow-up 1 week later
Ko et al 2009
Suggests that pain control is very significant to patients because it was a major factor in the willingness to return to endoscopy
Loftus et al 2013
Less pain when receiving Entonox (gas) compared to IV sedation (midazolam & fentanyl)
Maslekar et al 2009
Significant differences
Pain control - the most important factor associated with satisfaction
Maslekar et al 2009
Higher pain score were associated with poor patient satisfaction
Higher pain scores were significantly associated with greater levels of anxiety, female gender, longer procedure duration and lower depth of sedation
Eckardt et al 2008
31% stated that they had experienced pain after the procedure.
Altman et al 2006
Comfort
Gloucester Comfort Score
Interior
Temperature in the examination room
Denters et al. 2012
Comfortable endoscopy areas was associated with patient staisfaction
Scotto et al 2008
Endoscopy room cleanliness
Scotto et al 2008
NRCL (nurse reported comfort level)
Likert scale 5-point
Ekkelenkamp et al. 2013
Discomfort before the procedure (sedated pt)
Baudet et al. 2012
Overestimation of discomfort from both endoscopists and nurses compared to the patients experienced discomfort
Heuss et al 2012
Adequacy of control of discomfort during the procedure was the second most important factor for patient satisfaction
Yacavone et al 2001
NAPCOMS (nurse-assessed patient comfort score)
Rostrom et al 2013
Critisism: Validated scales to assess patients’ comfort during colonoscopyare important, but we believe that patient-rated
scales are more relevant when assessing comfort during individualprocedures, whereas nurse-rated scales may be
more useful as global quality assurance indicators
Ball & Riley 2013
There're significant differences in ratings between patients and nurses/endoscopists
Moderate level of agreement (ICC) between endoscopists and patients regarding comfort rate
Moderate correlation (intraclass correlation - ICC) between the rating made by patients and endoscopists
Rostrom et al 2013
Approximately 23% of the patients rated the experience of the colonoscopy as more uncomfortable then expected
de Jonge et al 2010
Despite the use of conscious sedation in 94% of the procedure
69% rated it as less uncomfortable then expected
Sint Nicolaas et al 2012
A significant association between pain during the examination and post-examination discomfort
Larsen et al 2002
Age was a significant factor - with older patients reporting less procedure associated discomfort
Voiosu et al 2014
Factors associated with discomfort
Younger age
Female sex
Salmon et al 1994
Women were significantly more likely than men to experience discomfort during their procedure.
Sincock et al 1999
A gastrointestinal fellow performing the procedure
Absence of sedation
Sint Nicolaas et al 2012
L-WISC (Intraprocedure comfort scale)
Reasonable interobserver agreement between endoscopists and nurses
Munson et al 2011
Poor agreement between nurses' and patients' comfort scores
Patient excellent 98%
Nurses 33%
Criticism: amnesia
Dignity and to be treated with respect and compassion
Most important factor for quality
Sewith et al 2013
Embarrassment
Ca colon screening
Mitchell et al 2012
Avoid screening due to embarrassment
Out of those who came for a colonoscopy the embarrassment was very low (7%)
Nicholson & Korman 2005
Communication
Staff communication skills
Reduce anxiety and enhance patient experiences
Toomey et al. 2016
Endoscopic-team
Patient/Endoscopist/Nurse-interaction
Heuss et al 2012
Discussion of the result and quality of the procedure is of importance for the patients'
McEntire et al 2013
Factor of importance for satisfaction is communication between doctor and patient.
Qureshi et al 2013
Information
Smart phone application
Bowel preparation
Lorenzo-Zuniga et al. 2015
Structured leaflets
Reduce anxiety and enhance patient experiences
Toomey et al. 2016
Information video
Decrease anxiety and abdominal pain
Arabul et al. 2012
No differences between groups (video/no video)
Bytzer & Lindeberg 2007
Before/Under/After
After
Written procedure report given to patients in connection with discharge
Intervention group had lower scores postprocedure anxiety but no significance was shown
Spodnik et al 2008
Patients undergoing colonoscopy were more likely to receive their results on the same day, by face-to-face and from the hospital
Significantly more satisfied with the way the results were conveyed (greater immediacy and more personal nature)
von Wagner et al 2012
Complete explanation of endoscopic diagnosis associated with patient satisfaction
Scotto et al 2008
Patients who receive the preliminary result from the endoscopist were more satisfied then those who did nit receive any information at all
Sint Nicolaas et al 2012
Explanations provided by medical and nursing staff, before and after the procedure are important factors for satisfaction
Yanai et al 2008
The second most important factor that contribute to satisfaction was explanations regarding examination
del Rio et al 2007
Detailed information, knowing what to expect on day of/during procedure
Third most important factor for quality
Sewitch et al 2013
Before
Patients who were more satisfied with the information offered before the procedure were more likely to report lower pain scores
Voiosu et al 2014
Should be aware that some patients are either not receiving or absorbing correct information about colonoscopy, specially regarding pain and sedation
Rollbusch et al 2014
Second most important factor for quality is clear instructions regarding preparation and information on side effects
Sewitch et al 2013
Explanation of the procedure before conducting it
Qureshi et al 2013
Under
Information about endoscopic procedure associated with patient satisfaction
Scotto et al 2088
Videotape about risks, benefits and alternatives to the procedure
Patients prefered a combination of video and discussion with physician
Agre et al 1997
Sedation
Medication-free
Ylinen et al. 2009
250 participant were invited to be randomized to have sedation or not, 65% refused thus they wanted sedation
Rex et al 1999
Out of those who accepted the study 74% were men
Analysis manifests (shows/appears) that male gender, increasing age and absence of abdominal pain were associated with willingness to try colonoscopy without sedation
It is likely that preprocedureal counseling and education affect the willingness of patients to try unsedated colonoscopy
Early et al 1999
Time consuming for patient
Ylinen et al. 2009
Increase complications
Ylinen et al 2009
Reduces fear and anxiety
Baudet et al. 2012
Läkemedel
Midazolam & Fentanyl
Baudet et al. 2012
Bytzer & Lindeberg 2007
Denters et al. 2012
Midazolam/Propofol/Pethidine/Alfentanil
Heuss et al. 2012
Diazepam
Salmon et al 1994
Increase pain
Nicholson & Korman 2005
Minimal sedation can result in a good patient experience
Sarkar et al 2012
Anxiety
Before/After
Before
Women and younger then 40
Baudet et al. 2012
Level of anxiety
Heuss et al 2012
Important to identify high levels of anxiety before the procedure
Nurses have a key role to play in this task
Ylinen et al 2009
For whom medication is pertinent
Reported lower procedure-related anxiety were more likely to have lower scores on the VAS scale indicating more comfort during the procedure
Voiosu et al 2014
Preprocedure anxiety differed significantly among coping style groups
Fox et al 1989
Preprocedure anxiety was often unfounded once the procedure was over
Mikocka-Walus et al 2012
Same general anxiety between women and men
Bytzer & Lindeberg 2007
Women's anxiety was higher then men's
Ylinen et al 2009
Patients undergoing diagnostic colonoscopy found the experience significantly more worrying than those patients on cancer follow-up
Salmon et al 1994
Doctor-patient interaction influences experienced anxiety
Mikocka-Walus et al 2012
High levels of anxiety
Family history
Desire to be healthy
Mikocka-Walus et al 2012
Overall experiences
Music during colonoscopy
Significant improved experiences
Bechtold et al. 2009
Women less satisfied then men
Bytzer & Lindeberg 2007
Survey at the unit gives higher satisfaction scores compared to surveys answered at home within 1 week after the procedure
Lin et al 2007
QoL is not affected (neigher in short nor in long term) by colonoscopy screening
Niv et al 2012
Factors that were associated with increased overall satisfaction
Waiting time
Waiting time was significantly associated with lower satisfaction scores
Eckardt et al 2008
The personal manners of the endoscopist
Less discomfort then expected
Higher acceptance of the procedure
Accurate knowledge of what to expect during colonoscopy may have a benefit for how patients perceive colonoscopy
Rollbusch et al 2014
The patient's perception of adequacy of pain control
The possibility to obtain preliminary results from staff
Sint Nicolaas et al 2012
Factor of importance for satisfaction is communication between doctor and patient.
Qureshi et al 2013
Factors of importance for patient satisfaction
Rating patient-generated issues-of-concern
Endoscopists
Physical symptoms
Pain
Abdominal cramp
Nausea/vomiting
Diarrhoe
Do not have a good perception of the items that contribute most to patient satisfaction with the colonoscopy procedure
Denters et al. 2012
Patients
Involving in decisions Discussing risks Complications Opportunity for questions
Uncertainty about the level of cleanliness of the bowel
Denters et al. 2012
Denters et al. 2012
Predictors for dissatisfaction
Nervousness and chronic use of psychotropic drugs
Pena et al 2005
Hospital cleanliness
Scotto et al 2008
Expectations
Better then expected, as expected, worse then expected
Ekkelenkamp et al. 2013
Survey
Standard mail Telephone E-mail
Harewood et al. 2001
Cost-efficient questionnaire
Face2Face vs Mail
Responsrate
Face2Face
95%
Before leaving the unit
Higher satisfaction compared to mail
Recommended method despite higher rates - cost-efficient/logistical easier
Mail
62%
Self-addressed postage-paid envelope
Asked to answer within 1 week
Lin et al 2007
Mail
Reminder/thank you
Replacement survey
Mitchell et al 2012 (Dillman 2000)
Survey before discharge measure is sufficient (compared with 1 week after)
Rostrom et al 2013
Not align with Ko et al 2009
Shows less satisfied in the follow-up
To compare web-based, mail & telephone
It is unclear when data collection occurred, reasonably in 2002, since the article was accepted in Jan 2003, and that was before the first iPhone sold out when it was launched in 2007
Outdated/obsolete study
Results with poor response rate - web-based
Harewood et al 2003
Interviewers read statements from a questionnaire
Scotto et al 2008
Structured interview
Telephone interview
Preferably due to minimum patient disruption and probably important factor for excellent respond rates
Sarkar et al 2012
Endoscopist skills
Nursing endoscopists
Patient satisfaction "OK"
van Putten et al 2012
Technical skills of the endoscopist were most important for patient satisfaction
Yacavone et al 2001
They never asked how the patients could assess these technical skills
Criticism from Yanai et al 2008
Based on the degree of pain during the procedure or the duration? Factors is yet to be determined
Ko et al 2009
The question about technical skills was replaced by Chan & Goh 2012
And by del Rio et al 2007
Poor response rate 44% - The perceived technical skills of the endoscopist was the factor with the highest association with willingness to return for repeat colonoscopy
Loftus et al 2013
Insufflation technique might have an impact of pain during and after procedure
Voiosu et al 2014
Nervousness
Before procedure - a predictor for aversive colonoscopy experience
Pena et al 2005
Scales
GHAA-9
Punkt 1-7 dvs utan willingness
ASGE patient satisfaction questionnaire
Pain is missing
Yacavone et al 2001
Utvecklat från GHAA
60 items
Davies & Ware 1991 GHAA's consumer satisfaction survey and user's manual (Group Health Association of America)
mGHAA-9
Studier som använt skalan
Yacavone et al 2001 Modified
Ko et al. 2009
Pain and discomfort is missing
Not validated
Face-validity & construct validity
Maslekar et al 2009
Azmi et al. 2012
Asian tertiary
ca. n=700
Interview 1: face2face direkt efter utskrivningsinformationen var given
Interview 2: Within 1 month from the day of the procedure
McEntire et al 2013 Modified
Chan & Goh 2012
Modified - endoscopists skills replaced with comfort during procedure and added comfort level during bowel preparation
del Rio et al 2007 Modified
Waiting time for appointment
Waiting time before procedure
Personal manner of the physician
Courtesy
Respect
Sensitivity
Friendliness
Personal manner of the nurses and support staff
Technical skills
Throughness
Carefulness
Competence
Adequacy of explanation of the procedure
Overall rating
Willingness to return to the same physician
Willingness to return to the same facility
Modifierad från GHAA-9 för att passa endoskopi
GRS
Valori 2012
Two dimensions
Quality of patient experience
Clinical care
Modified by Hlisden et al 2011
Items regarding information, interaction, privacy and satisfaction with the procedure were added
Modified by de Jonge et al 2010
Critisism - Acceptance of the GRS in the UK is high, however to date (2010) full-length peer-reviewed publications pertaining to the GRS are lacking
Med hänvisning till följande artiklar: Valori 2009, Dubé 2008 & Barton 2008
Compared items from focus group interviews with GRS
Missing items in GRS
Anxiety
Preprocedure meeting
Staff attitude
Service environment
Recovery area
Sewitch et al 2013
Validation (content) thru focus group interviews (n=26)
Williams et al 2013
Used in...
UK
Scotland
Wales
Northern Ireland
Canada?
The Netherlands
CES-13
Colonoscopy-related embarrassment
Mitchell et al 2012
SF-36
QoL
Niv et al 2012
PSSI/CSSI
Patient-/Clinician Satisfaction with Sedation Instrument
Vargo et al 2009
STAI
Ylinen et al 2009
Ko et al 2009
Post questionnaire: Pain and discomfort in the same question
Beck Anxiety Inventory (BAI)
Spodik et al 2008
EQ-5D
Modified with 5 questions for structured telephone interviews
Sarkar et al 2012
VAS vs. VRS-4
VAS demonstrates a higher sensitivity compared with VRS-4
Skovlund et al 2005
Preferable use VAS when measuring mild to moderate pain
VRS-4 = verbal rating scale
Both reliable and valid scales
L-WISC
Munson et al 2011
Ease of use
Willingness to return
Acceptance of repeat
Women only return if more medication
Bytzer & Lindeberg 2007
Endoscopists skills and pain control major factors for willingness to return
Loftus et al 2013
Patients within the screening program gave higher scores for "repeatability" compared with those patients who was outside the program
Sarkar et al 2012
When evaluating not only focus/concentrate on the endoscopy unit (too narrow) instead widen the evaluation and include other events and factors that could have an impact on the patients' overall impression of and the satisfaction with the experience
Could affect the willingness to return (blueprint!)
Cohen et al 1994
Identify the cycle of service is an important first step in designing a satisfaction measurement tool
Factors associated with willingness to return
Male sex
Absence of symptoms
Sint Nicolaas et al 2012
Factors associated with a decreased willingness to return
A burdensome experience with bowel preparation
A "rushed" staff attitude
More discomfort then expected
A low acceptance of the procedure
Sint Nicolaas et al 2012
Fear
Women and younger then 40
Baudet et al. 2012
No previous colonoscopy
Baudet et al. 2012
En av de vanligaste orsakerna för att inte välja att bli screenad
Baudet et al. 2012 (refererar till Harewood och Nicholson)
Primary reason for any fear
Heuss et al 2012
Bowel preparation
Women less satisfied then men
Lin et al 2007
Worst part of the (overall) procedure was the preparations
Nicholson & Korman 2005
Open-ended question: >8% indicated a negative experience with the bowel preparation
Yacavone et al 2001
Dietary restrictions
von Wagner et al 2012
First time to be included in satisfaction survey
Chan & Goh 2012
The main factors that contributed to unfavorable responses were comfort level during bowel preparation
The vast majority of negative comments were related to bowel preparation
Hilsden et al 2011
Better bowel preparation was significantly associated with a lower level of discomfort
Voiosu et al 2014
More burdensome experience for patients <50 years of age
Sint Nicolaas et al 2012
The preparation for colonoscopy is a barrier for patients, either it was inconvenient or because it was uncomfortable and unpleasant
Patients accept is since the preparation is a necessary part of colonoscopy and the procedure had to be done
Mikocka-Walus et al 2012
55% experiences difficulties to drink the solution
Altman et al 2006