title: Open access colonoscopy in the training setting: which factors affect patient satisfaction and pain?
abstract: OBJECTIVE
  Patient satisfaction with colonoscopy is important for quality assurance; it may be affected by various factors, including patient characteristics, physician training level, and procedural or organizational features. We aimed to analyze how these factors influenced patient satisfaction and pain in an outpatient training setting.
  
  
  METHODS
  Consecutive patients for open access colonoscopy (OAC) were enrolled in a prospective, single-blinded, controlled study. Primary and secondary outcomes were satisfaction and pain scores with and without trainee participation. A multivariate analysis was designed to achieve an 80 % power with an alpha value of 0.05.
  
  
  RESULTS
  368 patients were enrolled. Satisfaction with the procedure was high (mean score 1.36; 1 = best to 5 = worst). In the multivariate analysis only waiting time in the endoscopy suite was significantly associated with lower satisfaction scores ( P = 0.024). Satisfaction was unaffected by patient factors (gender, American Society of Anesthesiologists' [ASA] score, anxiety, etc). Higher pain scores were associated with higher anxiety levels ( P = 0.02), female gender ( P = 0.02), longer procedure ( P< 0.001), and lower sedation levels ( P = 0.001); trainee involvement (49 % of procedures) did not adversely affect satisfaction or pain scores.
  
  
  CONCLUSIONS
  Patient satisfaction with OAC using sedation appears to depend primarily on organizational factors (waiting time beforehand). In contrast, pain is associated with patient characteristics (female gender, anxiety) and procedural factors (lower sedation, longer procedure). Trainee participation did not affect satisfaction or pain scores, a finding which may help to reassure patients undergoing OAC with trainee participation.
authors.affiliation: Division of Gastroenterology and Hepatology, UMass Memorial Medical Center, Worcester, Massachusetts, United States. alexander.eckardt@charite.de
authors.forename: A J
authors.initials: AJ
authors.lastname: Eckardt
authors.forename: C
authors.initials: C
authors.lastname: Swales
authors.forename: K
authors.initials: K
authors.lastname: Bhattacharya
authors.forename: W Y
authors.initials: WY
authors.lastname: Wassef
authors.forename: N P
authors.initials: NP
authors.lastname: Phelan
authors.forename: S
authors.initials: S
authors.lastname: Zubair
authors.forename: N
authors.initials: N
authors.lastname: Martins
authors.forename: S
authors.initials: S
authors.lastname: Patel
authors.forename: B
authors.initials: B
authors.lastname: Moquin
authors.forename: N
authors.initials: N
authors.lastname: Anwar
authors.forename: K
authors.initials: K
authors.lastname: Leung
authors.forename: J M
authors.initials: JM
authors.lastname: Levey
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011336:Probability; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016037:Single-Blind Method