School of Nursing and Paramedic Science, Ulster University, Londonderry, United Kingdom.
Centre for Research and Technology Hellas, Thessaloniki, Greece.
J Med Internet Res. 2023 Apr 14;25:e45181. doi: 10.2196/45181.
Colonoscopy is the gold standard for lower gastrointestinal diagnostics. The procedure is invasive, and its demand is high, resulting in long waiting times. Colon capsule endoscopy (CCE) is a procedure that uses a video capsule to investigate the colon, meaning that it can be carried out in a person's own home. This type of "hospital-at-home" service could potentially reduce costs and waiting times, and increase patient satisfaction. Little is currently understood, however, about how CCE is actually experienced and accepted by patients.
The aim of this study was to capture and report patient experiences of the CCE technology (the capsule and associated belt and recorder) and of the new clinical pathway for the CCE service being rolled out as part of routine service in Scotland.
This was a mixed methods service evaluation of patient experiences of a real-world, deployed, managed service for CCE in Scotland. Two hundred and nine patients provided feedback via a survey about their experiences of the CCE service. Eighteen of these patients took part in a further telephone interview to capture more in-depth lived experiences to understand the barriers and opportunities for the further adoption and scaling up of the CCE service in a way that supports the patient experience and journey.
Patients overall perceived the CCE service to be of significant value (eg, mentioning reduced travel times, reduced waiting times, and freedom to complete the procedure at home as perceived benefits). Our findings also highlighted the importance of clear and accessible information (eg, what to expect and how to undertake the bowel preparation) and the need for managing expectations of patients (eg, being clear about when results will be received and what happens if a further colonoscopy is required).
The findings led to recommendations for future implementations of managed CCE services in National Health Service (NHS) Scotland that could also apply more widely (United Kingdom and beyond) and at a greater scale (with more patients in more contexts). These include promoting CCE with, for, and among clinical teams to ensure adoption and success; capturing and understanding reasons why patients do and do not opt for CCE; providing clear information in a variety of appropriate ways to patients (eg, around the importance of bowel preparation instructions); improving the bowel preparation (this is not specific to CCE alone); providing flexible options for issuing and returning the kit (eg, dropping off at a pharmacy); and embedding formative evaluation within the service itself (eg, capturing patient-reported experiences via surveys in the information pack when the equipment is returned).
结肠镜检查是下消化道诊断的金标准。该程序具有侵入性，需求很高，导致等待时间长。结肠胶囊内镜（CCE）是一种使用视频胶囊检查结肠的方法，这意味着它可以在患者自己的家中进行。这种“医院到家”的服务可能会降低成本和等待时间，并提高患者满意度。然而，目前对于 CCE 实际上是如何被患者体验和接受的，人们知之甚少。
本研究旨在描述 CCE 技术（胶囊和相关腰带和记录仪）以及苏格兰常规服务中推出的 CCE 服务新临床途径的患者体验，并报告这些体验。
这是对苏格兰 CCE 真实、部署、管理服务的患者体验进行的混合方法服务评估。209 名患者通过调查提供了他们对 CCE 服务体验的反馈。其中 18 名患者参加了进一步的电话访谈，以更深入地了解生活体验，了解 CCE 服务进一步采用和扩大的障碍和机会，以支持患者体验和旅程。
患者总体上认为 CCE 服务具有重要价值（例如，提到减少旅行时间、减少等待时间以及在家中完成程序的自由）。我们的研究结果还强调了清晰和可访问的信息的重要性（例如，期望什么以及如何进行肠道准备），并需要管理患者的期望（例如，明确何时将收到结果以及如果需要进一步进行结肠镜检查该怎么办）。
这些发现为苏格兰国民保健服务（NHS）中管理 CCE 服务的未来实施提出了建议，这些建议也可以更广泛地（英国和其他地区）和更大规模地（更多患者在更多情况下）应用。这些建议包括：促进 CCE 在临床团队中的采用和成功；了解患者选择和不选择 CCE 的原因；以各种适当的方式向患者提供清晰的信息（例如，肠道准备说明的重要性）；改善肠道准备（这不仅限于 CCE 本身）；为试剂盒的发放和归还提供灵活的选择（例如，在药店归还）；并在服务本身中嵌入形成性评估（例如，在归还设备时通过信息包中的调查来捕获患者报告的体验）。
