title: "It is just another test they want to do": Patient and caregiver understanding of the colonoscopy procedure.
abstract: OBJECTIVE
  Colonoscopy is a complex procedure that requires bowel preparation, sedation, and has the potential for substantial risk. Given this, we investigated colonoscopy patients' perceived and actual understanding of the procedure.
  
  
  METHODS
  Consecutive colonoscopy patients were enrolled and surveyed, with their caregivers, immediately prior to their procedure. Demographics, health literacy, socioeconomic status and perceived risks/benefits were assessed. Thematic analysis was conducted on open-ended responses and a 3-level outcome variable was created to categorize correctness of patients' and caregivers' understanding. Multinomial logistic regression was used to determine predictors of response level.
  
  
  RESULTS
  Patients (N=1821) were 77% White, 60% female, and averaged 54 years old; caregivers were demographically similar. Among patients, bivariate analysis revealed that younger age, minority race, and low income, education, and health literacy were associated with incomplete understanding. Multinomial regression revealed that age, education, health literacy, first-time colonoscopy, and perceived risk-benefit difference discriminated among groups. Bivariate and multinomial results for caregivers were similar.
  
  
  CONCLUSIONS
  Patients and caregivers varied on information, understanding and misconceptions about colonoscopy. Implications are discussed for inadequate: 1. informed consent, 2. bowel preparation, and 3. emotional preparation for cancer detection or adverse events.
  
  
  CONCLUSIONS
  Attention should be paid to patients' understanding of the purpose, anatomy, and logistics of colonoscopy, preferably prior to bowel preparation.
authors.affiliation: Department of Behavioral Science and Community Health, University of Florida, Gainesville, USA. Electronic address: eckm@umd.edu.
authors.forename: Evelyn C
authors.initials: EC
authors.lastname: King-Marshall
authors.affiliation: Department of Behavioral and Community Health, University of Maryland, College Park, USA.
authors.forename: Nora
authors.initials: N
authors.lastname: Mueller
authors.affiliation: Department of Health Sciences, Gettysburg College, Gettysburg, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Dailey
authors.affiliation: Department of Behavioral Science and Community Health, University of Florida, Gainesville, USA.
authors.forename: Tracey E
authors.initials: TE
authors.lastname: Barnett
authors.affiliation: Department of Medicine, University of Florida, Gainesville, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: George
authors.affiliation: Department of Medicine, University of Florida, and North Florida/South Georgia Veterans Affairs Medical Center, Gainesville, USA.
authors.forename: Shanaz
authors.initials: S
authors.lastname: Sultan
authors.affiliation: Department of Behavioral Science and Community Health, University of Florida, Gainesville, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Curbow
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D032882:Comprehension; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D012307:Risk Factors; D012959:Socioeconomic Factors
keywords: Benefits; Caregivers; Colonoscopy; Colorectal cancer; Decision-making; Health literacy; Informed consent; Patient; Risks; Screening