title: A literature review of quality in lower gastrointestinal endoscopy from the patient perspective.
abstract: BACKGROUND
  Given the limited state of health care resources, increased demand for colorectal cancer (CRC) screening raises concerns about the quality of endoscopy services. Little is known about quality in colonoscopy and endoscopy from the patient perspective.
  
  
  OBJECTIVE
  To systematically review the literature on quality that is relevant to patients who require colonoscopy or endoscopy services.
  
  
  METHODS
  A systematic PubMed search was performed on articles that were published between January 2000 and February 2011. Keywords included "colonoscopy" or "sigmoidoscopy" or "endoscopy" AND "quality"; "colonoscopy" or "sigmoidoscopy" or "endoscopy" AND "patient satisfaction" or "willingness to return". The included articles were qualitative and quantitative English language studies regarding aspects of colonoscopy and⁄or endoscopy services that were evaluated by patients in which data were collected within one year of the colonoscopy⁄endoscopy procedure.
  
  
  RESULTS
  In total, 28 quantitative studies were identified, of which eight (28.6%) met the inclusion criteria (four cross-sectional, three prospective cohort and one single-blinded controlled study). Aspects of quality included comfort, management of pain and anxiety, endoscopy unit staff manner, skills and specialty, procedure and results discussion with the doctor, physical environment, wait times for the appointment and procedure, and discharge. Qualitative studies eliciting the patient perspective on what constituted quality in colonoscopy⁄endoscopy were not found.
  
  
  CONCLUSIONS
  Factors related to comfort, staff, communication and the service environment were evaluated from the patient perspective using closed-ended questions that were designed by clinicians and researchers. Future research using qualitative methodology to elicit the patient perspective on quality in colonoscopy and⁄or endoscopy services is needed.
authors.affiliation: Department of Medicine, McGill University, Montreal, Quebec, Canada. maida.sewitch@mcgill.ca
authors.forename: Maida J
authors.initials: MJ
authors.lastname: Sewitch
authors.forename: Shasha
authors.initials: S
authors.lastname: Gong
authors.forename: Catherine
authors.initials: C
authors.lastname: Dube
authors.forename: Alan
authors.initials: A
authors.lastname: Barkun
authors.forename: Robert
authors.initials: R
authors.lastname: Hilsden
authors.forename: David
authors.initials: D
authors.lastname: Armstrong
mesh_terms: D003113:Colonoscopy / Q000592:standards*; D016099:Endoscopy, Gastrointestinal / Q000592:standards*; D006801:Humans; D007398:Interpersonal Relations; D017060:Patient Satisfaction; D011216:Practice Management, Medical; D019984:Quality Indicators, Health Care; D014850:Waiting Lists