Silvester Jocelyn A, Kalkat Harmandeep, Graff Lesley A, Walker John R, Singh Harminder, Duerksen Donald R
Jocelyn A Silvester, Harmandeep Kalkat, Lesley A Graff, John R Walker, Harminder Singh, Donald R Duerksen, Faculty of Health Sciences, College of Medicine, University of Manitoba, Winnipeg, MB R2H 2A6, Canada.
World J Gastrointest Endosc. 2016 Nov 16;8(19):701-708. doi: 10.4253/wjge.v8.i19.701.
To investigate the effects of direct to colonoscopy pathways on information seeking behaviors and anxiety among colonoscopy-naïve patients.
Colonoscopy-naïve patients at two tertiary care hospitals completed a survey immediately prior to their scheduled outpatient procedure and before receiving sedation. Survey items included clinical pathway (direct or consult), procedure indication (cancer screening or symptom investigation), telephone and written contact from the physician endoscopist office, information sources, and pre-procedure anxiety. Participants reported pre-procedure anxiety using a 10 point scale anchored by "very relaxed" (1) and "very nervous" (10). At least three months following the procedure, patient medical records were reviewed to determine sedative dose, procedure indications and any adverse events. The primary comparison was between the direct and consult pathways. Given the very different implications, a secondary analysis considering the patient-reported indication for the procedure (symptoms or screening). Effects of pathway (direct consult) were compared both within and between the screening and symptom subgroups.
Of 409 patients who completed the survey, 34% followed a direct pathway. Indications for colonoscopy were similar in each group. The majority of the participants were women (58%), married (61%), and internet users (81%). The most important information source was family physicians (Direct) and specialist physicians (Consult). Use of other information sources, including the internet (20% 18%) and Direct family and friends (64% 53%), was similar in the Direct and Consult groups, respectively. Only 31% of the 81% who were internet users accessed internet health information. Most sought fundamental information such as what a colonoscopy is or why it is done. Pre-procedure anxiety did not differ between care pathways. Those undergoing colonoscopy for symptoms reported greater anxiety [mean 5.3, 95%CI: 5.0-5.7 (10 point Likert scale)] than those for screening colonoscopy (4.3, 95%CI: 3.9-4.7).
Procedure indication (cancer screening or symptom investigation) was more closely associated with information seeking behaviors and pre-procedure anxiety than care pathway.
探讨直接结肠镜检查途径对初次接受结肠镜检查患者信息寻求行为和焦虑的影响。
两家三级护理医院中初次接受结肠镜检查的患者在预定的门诊检查前且在接受镇静之前完成一项调查。调查项目包括临床途径（直接或咨询）、检查指征（癌症筛查或症状调查）、来自内镜医师办公室的电话和书面联系、信息来源以及检查前焦虑。参与者使用从“非常放松”（1分）到“非常紧张”（10分）的10分制量表报告检查前焦虑。在检查后至少三个月，查阅患者病历以确定镇静剂量、检查指征和任何不良事件。主要比较是在直接途径和咨询途径之间。鉴于意义差异很大，进行了一项次要分析，考虑患者报告的检查指征（症状或筛查）。在筛查和症状亚组内以及亚组之间比较途径（直接与咨询）的影响。
在完成调查的409名患者中，34%采用直接途径。每组中结肠镜检查的指征相似。大多数参与者为女性（58%）、已婚（61%）且是互联网用户（81%）。最重要的信息来源在直接途径组中是家庭医生，在咨询途径组中是专科医生。直接途径组和咨询途径组中分别使用其他信息来源（包括互联网，直接途径组20%，咨询途径组18%）以及家人和朋友（直接途径组64%，咨询途径组53%）的情况相似。在81%的互联网用户中，只有31%访问了互联网健康信息。大多数人寻求的是基本信息，如结肠镜检查是什么或为什么要做。检查前焦虑在护理途径之间没有差异。因症状接受结肠镜检查的患者报告的焦虑程度[平均值5.3，95%可信区间：5.0 - 5.7（10分量表）]高于进行筛查结肠镜检查的患者（4.3，95%可信区间：3.9 - 4.7）。
与护理途径相比，检查指征（癌症筛查或症状调查）与信息寻求行为和检查前焦虑的关联更为密切。
