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患者使用结肠镜检查作为阳性 FOBT/FIT 后诊断测试的体验:定量文献的系统评价。

Patients' experience of using colonoscopy as a diagnostic test after a positive FOBT/FIT: a systematic review of the quantitative literature.

机构信息

Department of Behavioural Science and Health, University College London, London, UK

School of Health Science, University of Surrey, Guildford, UK.

出版信息

BMJ Open. 2023 Sep 21;13(9):e071391. doi: 10.1136/bmjopen-2022-071391.

Abstract

OBJECTIVES

Faecal occult blood testing (FOBT) and faecal immunochemical testing (FIT) are among the most used screening modalities for colorectal cancer (CRC). Colonoscopy is also widely used as a screening and diagnostic test for adults with a positive FOBT/FIT. Patient experience of colonoscopy is an important component for most CRC screening programmes. Individuals with negative experiences are less likely to engage with colonoscopy in the future and can deter others from attending colonoscopy when invited. This review synthesised data on patient experience with colonoscopy, following a positive result, to provide insights into how to improve patient experience within the English Bowel Cancer Screening Programme.

METHODS

MEDLINE, EMBASE and PsycINFO were searched for quantitative questionnaire studies evaluating patient-reported experience with colonoscopy, following a positive screening FOB/FIT result. The search was limited to studies published between 2000 and 2021 (ie, when the first FOBT/FIT screening programmes for CRC were introduced). Data-driven and narrative summary techniques were used to summarise the literature.

RESULTS

In total, six studies from the UK (n=4), Spain (n=1) and the Netherlands (n=1) were included in the review (total participants: 152 329; response rate: 68.0-79.3%). Patient experiences were categorised into three 'stages': 'pre-colonoscopy', 'during the test' and 'post-colonoscopy'. Overall, patients reported a positive experience in all six studies. Bowel preparation was the most frequently endorsed issue experienced pre-test (experienced by 10.0-41.0% of individuals, across all studies), pain and discomfort for during the test (experienced by 10.0-21.0% of participants) and abdominal pain and discomfort after the test (these were experienced by 14.8-22% of patients).

CONCLUSION

This review highlighted that patient-reported experiences associated with colonoscopy were generally positive. To improve the colonoscopy experience, bowel screening centres should investigate means to: make bowel preparation more acceptable, make colonoscopy less painful and reduce post-colonoscopy symptoms.

摘要

目的

粪便潜血检测(FOBT)和粪便免疫化学检测(FIT)是结直肠癌(CRC)最常用的筛查方法之一。结肠镜检查也被广泛用于 FOBT/FIT 阳性的成年人的筛查和诊断。患者对结肠镜检查的体验是大多数 CRC 筛查项目的重要组成部分。体验不佳的患者将来不太可能接受结肠镜检查,并且当被邀请时,他们可能会阻止其他人参加结肠镜检查。本综述综合了阳性筛查 FOB/FIT 结果后患者对结肠镜检查体验的数据,以提供如何改善英国结直肠癌筛查计划内患者体验的见解。

方法

在 2000 年至 2021 年(即首次引入 CRC 的 FOBT/FIT 筛查计划时)期间,我们在 MEDLINE、EMBASE 和 PsycINFO 中搜索了定量问卷调查研究,评估了阳性筛查 FOB/FIT 结果后患者对结肠镜检查的报告体验。数据驱动和叙述性总结技术用于总结文献。

结果

共有来自英国(n=4)、西班牙(n=1)和荷兰(n=1)的 6 项研究纳入本综述(总参与者:152329 人;应答率:68.0-79.3%)。患者体验分为三个“阶段”:“结肠镜检查前”、“检查期间”和“检查后”。总体而言,所有 6 项研究中的患者均报告了积极的体验。肠道准备是测试前最常被报告的问题(在所有研究中,有 10.0-41.0%的人经历过),检查期间疼痛和不适(有 10.0-21.0%的参与者经历过),检查后腹痛和不适(这些在 14.8-22%的患者中经历过)。

结论

本综述强调,与结肠镜检查相关的患者报告体验总体上是积极的。为了改善结肠镜检查体验,肠道筛查中心应研究如何使肠道准备更易接受,使结肠镜检查痛苦减轻,并减少结肠镜检查后的症状。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cfa/10514644/4a9f58f2cc26/bmjopen-2022-071391f01.jpg

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