Impact of an information video before colonoscopy on patient satisfaction and anxiety - a randomized trial

Background and study aims: Anxiety before colonoscopy may have adverse consequences and increase requirements for sedation and analgesics. We aimed to examine the effects of adding an information video to our usual preprocedural information.

Patients and methods: 162 colonoscopy patients were randomly assigned to video (72) or no video (90) groups. Patients in the video group watched a video on colonoscopy procedures and cleansing. The patients’ situational anxiety was measured using the State-Trait Anxiety Inventory (STAI) questionnaire. Patients rated pain and overall satisfaction related to the procedure. The colonoscopist and the endoscopy nurse, who were blinded to the patient’s allocation, completed questionnaires on use of medication, procedure outcome, and their assessments of patient pain and toleration of the procedure.

Results: There were no differences between the two groups concerning situational anxiety (mean STAI-State score 45.0 ± 13.3 vs. 45.9 ± 12.9, P = 0.7), rating of pain, tolerability of the procedure, or the willingness to undergo a future colonoscopy. The staff rated the outcomes equally in the two groups. There was no difference in use of midazolam, but patients, who had seen the video used higher doses of fentanyl (P < 0.02). Situational anxiety ratings were significantly higher in women, and they found the procedure significantly more painful (P = 0.001) and were less satisfied (P < 0.05).

Conclusions: An information video shown to patients preparing for colonoscopy had no impact on tolerability or anxiety. Colonoscopy is less tolerable and more painful for women and this is probably related to a higher degree of anxiety. Endoscopy personnel should be aware of these gender differences and adjust information and medication accordingly.

References

• 1 Froehlich F, Thorens J, Schwizer W. et al . Sedation and analgesia for colonoscopy: patient tolerance, pain, and cardiorespiratory parameters.  Gastrointest Endosc. 1997;  45 1-9
• 2 Jones M P, Ebert C C, Sloan T. et al . Patient anxiety and elective gastrointestinal endoscopy.  J Clin Gastroenterol. 2004;  38 35-40
• 3 Ristikankare M, Hartikainen J, Heikkinen M. et al . The effects of gender and age on the colonoscopic examination.  J Clin Gastroenterol. 2001;  32 69-75
• 4 Lopez-Cepero Andrada J M, Amaya V A. et al . Anxiety during the performance of colonoscopies: modification using music therapy.  Eur J Gastroenterol Hepatol. 2004;  16 1381-1386
• 5 Takahashi Y, Tanaka H, Kinjo M. et al . Prospective evaluation of factors predicting difficulty and pain during sedation-free colonoscopy.  Dis Colon Rectum. 2005;  48 1295-1300
• 6 Luck A, Pearson S, Maddern G. et al . Effects of video information on precolonoscopy anxiety and knowledge: a randomised trial.  Lancet. 1999;  354 2032-2035
• 7 Agre P, Kurtz R C, Krauss B J. A randomized trial using videotape to present consent information for colonoscopy.  Gastrointest Endosc. 1994;  40 271-276
• 8 Ness R M, Manam R, Hoen H. et al . Predictors of inadequate bowel preparation for colonoscopy.  Am J Gastroenterol. 2001;  96 1797-1802
• 9 Pearson S, Maddern G J, Hewett P. Interacting effects of preoperative information and patient choice in adaptation to colonoscopy.  Dis Colon Rectum. 2005;  48 2047-2054
• 10 Spielberger C D, Gorsuch R L, Lushene R E. Manual for the State-Trait Anxiety Inventory. Palo Alto; Consulting Psychologists Press Inc 1970
• 11 Morgan J, Roufeil L, Kaushik S. et al . Influence of coping style and precolonoscopy information on pain and anxiety of colonoscopy.  Gastrointest Endosc. 1998;  48 119-127
• 12 Lanius M, Zimmermann P, Heegewaldt H. et al . Does an information booklet on gastrointestinal endoscopy reduce anxiety for these examinations? Results of a randomized study with 379 patients.  Z Gastroenterol. 1990;  28 651-655
• 13 Brandt L J. Patients’ attitudes and apprehensions about endoscopy: how to calm troubled waters.  Am J Gastroenterol. 2001;  96 280-284
• 14 Tawil A, Dew M J. Does sending a video to patients lead to better informed consent?.  Gut. 2006;  55 Suppl 2 A53-A54
• 15 Ramakrishnan S, Yiannakou J Y, Butler T. et al . Colonoscopy induced pain: nurses are better at assessing this than doctors.  Gut. 2004;  53 A39
• 16 Hayee B H, Wong M, Rowbotham D S. et al . Assessing pain during colonoscopy: who guides sedation?.  Gut. 2006;  55 Suppl 2 A69
• 17 Tohda G, Higashi S, Wakahara S. et al . Propofol sedation during endoscopic procedures: safe and effective administration by registered nurses supervised by endoscopists.  Endoscopy. 2006;  38 360-367
• 18 Eckardt V F, Kanzier G, Willems D. et al . Colonoscopy without premedication versus barium enema: a comparison of patient discomfort.  Gastrointest Endosc. 1996;  44 177-180
• 19 Kim W H, Cho Y J, Park J Y. et al . Factors affecting insertion time and patient discomfort during colonoscopy.  Gastrointest Endosc. 2000;  52 600-605
• 20 Ladas S D. Factors predicting the possibility of conducting colonoscopy without sedation.  Endoscopy. 2000;  32 688-692
• 21 Lim C H, Ng D, Ahmed M M. Factors predicting a successful colonoscopy.  Gut. 2006;  55 Suppl 2 A68