Predictors of patient satisfaction after colonoscopy: A prospective study of 601 patients

Purpose: Over half of patients undergoing colonoscopy can tolerate the procedure without receiving sedation; however, many individuals remember their experience as relatively painful. We attempted to identify factors predictive of which patients might be good candidates to undergo colonoscopy without sedation. Methods: Consecutive outpatients undergoing colonoscopy (n=601, mean age=58; % male=52) rated the degree of discomfort which they expected to experience during the procedure on a visual analogue scale from 0 (No Discomfort) to 10 (Awful Discomfort). After the procedure, patients characterized their experience using the same scale. Results: The mean pain score was 4.7, with 20% reporting a score of <3, and 17% recording a score of >7. Four patient characteristics were associated with significantly lower mean pain scores (P< 0.05), but the magnitude of the differences was slight. These included male sex, age ≥ 65 years, education beyond high school, and no history of abdominal pain. None of these variables were significant in identifying the subset of individuals who had a particularly low discomfort rating (<3). Patient expectations about discomfort during the procedure was another significant, but much more powerful, predictor of lower mean post-colonoscopy scores. A low (<3) anticipated discomfort rating was significantly associated with a post-procedure score <3. Patient Group: % Score<3 in group % Score<3 not in group Predicted score <3 46*16 Age ≥ 65 21 19 Male sex 20 19 College education 22 16 No pain on history 18 20*P<0.05 Among patients at lower risk for having discomfort, we compared the scores of those who received no sedation with those who had been given a low dose of midazolam. The mean score was 23% lower in the group who received sedation, but this difference was not significant (mean score 3.7 vs. 4.8; p=0.097). Conclusion: These patient characteristics cannot be used to predict accurately which patients will tolerate an unsedated colonoscopy. Among individuals felt to be at low risk for experiencing discomfort, there may be some benefit to administering a low dose of midazolam, although a significant reduction in comfort score was not observed. Anticipation of pain is the most important predictor of overall post-procedure discomfort.