Hacker Katrina S, Curley Michael A, Siegel Corey A, Salwen-Deremer Jessica K
Department of Psychiatry, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
Center for Digestive Health, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
Therap Adv Gastroenterol. 2025 Jun 21;18:17562848251346250. doi: 10.1177/17562848251346250. eCollection 2025.
About half of the patients having colonoscopies experience procedure-related anxiety and emotional distress, which are associated with negative outcomes, including pain, higher sedation needs, longer procedure times, and avoidance of future care.
To improve procedure quality, we sought to understand from the patient's perspective the emotional and psychological aspects of undergoing a colonoscopy and recommendations for improving care.
Qualitative interview study.
We conducted semi-structured interviews with patients after colonoscopy. Questions were informed by the theoretical frame of trauma-informed care and fieldwork and collaborative discussions with endoscopists, multidisciplinary staff, and patients. Patients were recruited through purposive sampling to reflect a range of indications for colonoscopy, demographics, and health backgrounds. Interviews and data analysis were conducted in overlapping phases to ensure a diversity of perspectives. Thematic analysis was used to identify shared patterns across the data.
Nine patients completed interviews, and analysis generated the central dialectic "it's a tool, it's got hardships," reflecting a shared belief that colonoscopies are both stressful and important to one's health. Within this uniting concept, we identified themes of patient, provider, and process factors that have the potential to reduce or promote distress. Subthemes related to patients' past experiences/expectations, coping, and access to support; providers' communication and behavior; and process factors including prep/wait times, sedation and anesthesia, and team-based care. Factors that buffered against distress included perceived trust, transparency, and confidence; positive expectations rooted in prior healthcare experiences; flexible coping and feeling supported. Factors that contributed to increased vulnerability included having a minoritized identity, a history of past medical trauma, and uncertainty in communication and the colonoscopy process.
Efforts to improve the colonoscopy experience should continue to address the interplay of these complex factors. Given that identification of those at the highest risk for distress may not always be possible, we recommend a universal trauma-informed approach and provide specific suggestions for implementation in endoscopy.
约一半接受结肠镜检查的患者会经历与检查过程相关的焦虑和情绪困扰，这与负面结果相关，包括疼痛、更高的镇静需求、更长的检查时间以及回避未来的治疗。
为了提高检查质量，我们试图从患者的角度了解接受结肠镜检查的情绪和心理方面，以及改善护理的建议。
定性访谈研究。
我们在患者接受结肠镜检查后进行了半结构化访谈。问题基于创伤知情护理的理论框架、实地调查以及与内镜医师、多学科工作人员和患者的协作讨论。通过目的抽样招募患者，以反映结肠镜检查的一系列适应证、人口统计学特征和健康背景。访谈和数据分析在重叠阶段进行，以确保观点的多样性。采用主题分析法识别数据中的共同模式。
9名患者完成了访谈，分析得出核心辩证法“它是一种工具，也有艰难之处”，反映了一种共同信念，即结肠镜检查对健康既压力重重又至关重要。在这个统一概念中，我们确定了可能减少或加剧困扰的患者、提供者和过程因素主题。与患者过去的经历/期望、应对方式和获得支持的途径相关的子主题；提供者的沟通和行为；以及包括准备/等待时间、镇静和麻醉以及团队护理在内的过程因素。减轻困扰的因素包括感知到的信任、透明度和信心；源于既往医疗经历的积极期望；灵活的应对方式和感到得到支持。导致易感性增加的因素包括具有少数群体身份、过去有医疗创伤史以及沟通和结肠镜检查过程中的不确定性。
改善结肠镜检查体验的努力应继续关注这些复杂因素的相互作用。鉴于可能并非总能识别出困扰风险最高的人群，我们建议采用普遍的创伤知情方法，并提供在内镜检查中实施的具体建议。
