title: Patients' experience of colonoscopy in the English Bowel Cancer Screening Programme.
abstract: OBJECTIVE
  Understanding patients' experience of screening programs is crucial for service improvement. The English Bowel Cancer Screening Programme (BCSP) aims to achieve this by sending out questionnaires to all patients who undergo a colonoscopy following an abnormal fecal occult blood test result. This study used the questionnaire data to report the experiences of these patients.
  
  
  METHODS
  Data on patients who underwent colonoscopy between 2011 and 2012 were extracted from the BCSP database. Descriptive statistics were used to summarize key questionnaire items relating to informed choice, psychological wellbeing, physical experience, and after-effects. Multilevel logistic regression was used to test for associations with variables of interest: sex, age, socioeconomic status, colonoscopy results, and screening center performance (adenoma detection rate, cecal intubation rate, proportion of colonoscopies involving sedation).
  
  
  RESULTS
  Data from 50,858 patients (79.3 % of those eligible) were analyzed. A majority reported a positive experience on items relating to informed choice (e. g. 95.7 % felt they understood the risks) and psychological wellbeing (e. g. 98.3 % felt they were treated with respect). However, an appreciable proportion experienced unexpected test discomfort (21.0 %) or pain at home (14.8 %). There were few notable demographic differences, although women were more likely than men to experience unexpected discomfort (25.1 % vs. 18.0 %; P < 0.01) and pain at home (18.2 % vs. 12.3 %; P < 0.01). No associations with center-level variables were apparent.
  
  
  CONCLUSIONS
  Colonoscopy experience was generally positive, suggesting high satisfaction with the BCSP. Reported pain and unexpected discomfort were more negative than most other outcomes (particularly for women); measures to improve this should be considered.
authors: Department of Epidemiology and Public Health, University College London, London, United Kingdom.
authors: Alex
authors: A
authors: Ghanouni
authors: Centre for Medical Imaging, University College London, London, United Kingdom.
authors: Andrew
authors: A
authors: Plumb
authors: Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors: Paul
authors: P
authors: Hewitson
authors: NHS Cancer Screening Programmes, Sheffield, United Kingdom.
authors: Claire
authors: C
authors: Nickerson
authors: South Tyneside NHS Foundation Trust, South Tyneside School of Medicine, Pharmacy and Health, Durham University, Durham, United Kingdom.
authors: Colin J
authors: CJ
authors: Rees
authors: Department of Epidemiology and Public Health, University College London, London, United Kingdom.
authors: Christian
authors: C
authors: von Wagner
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging*; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000000981:diagnostic imaging*; D003113:Colonoscopy; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires