Patient experience of CT colonography and colonoscopy after fecal occult blood test in a national screening programme.
OBJECTIVE
To investigate patient experience of CT colonography (CTC) and colonoscopy in a national screening programme.


METHODS
Retrospective analysis of patient experience postal questionnaires. We included screenees from a fecal occult blood test (FOBt) based screening programme, where CTC was performed when colonoscopy was incomplete or deemed unsuitable. We analyzed questionnaire responses concerning communication of test risks, test-related discomfort and post-test pain, as well as complications. CTC and colonoscopy responses were compared using multilevel logistic regression.


RESULTS
Of 67,114 subjects identified, 52,805 (79 %) responded. Understanding of test risks was lower for CTC (1712/1970 = 86.9 %) than colonoscopy (48783/50975 = 95.7 %, p < 0.0001). Overall, a slightly greater proportion of screenees found CTC unexpectedly uncomfortable (506/1970 = 25.7 %) than colonoscopy (10,705/50,975 = 21.0 %, p < 0.0001). CTC was tolerated well as a completion procedure for failed colonoscopy (unexpected discomfort; CTC = 26.3 %: colonoscopy = 57.0 %, p < 0.001). Post-procedural pain was equally common (CTC: 288/1970,14.6 %, colonoscopy: 7544/50,975,14.8 %; p = 0.55). Adverse event rates were similar in both groups (CTC: 20/2947 = 1.2 %; colonoscopy: 683/64,312 = 1.1 %), but generally less serious with CTC.


CONCLUSIONS
Even though CTC was reserved for individuals either unsuitable for or unable to complete colonoscopy, we found only small differences in test-related discomfort. CTC was well tolerated as a completion procedure and was extremely safe. CTC can be delivered across a national screening programme with high patient satisfaction.


CONCLUSIONS
• High patient satisfaction at CTC is deliverable across a national screening programme. • Patients who cannot tolerate screening colonoscopy are likely to find CTC acceptable. • CTC is extremely safe; complications are rare and almost never serious. • Patients may require more detailed information regarding the expected discomfort of CTC.
Centre for Medical Imaging, Division of Medicine, University College London, 3rd Floor East, 250 Euston Road, London, NW1 2PG, UK. andrew.plumb@ucl.ac.uk.
Andrew A
AA
Plumb
Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK.
Alex
A
Ghanouni
Durham University School of Medicine, Pharmacy and Health, Durham, UK.
Colin J
CJ
Rees
Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Paul
P
Hewitson
NHS Cancer Screening Programmes, Fulwood House, Sheffield, UK.
Claire
C
Nickerson
NHS Cancer Screening Programmes, Fulwood House, Sheffield, UK.
Suzanne
S
Wright
Centre for Medical Imaging, Division of Medicine, University College London, 3rd Floor East, 250 Euston Road, London, NW1 2PG, UK.
Stuart A
SA
Taylor
Centre for Medical Imaging, Division of Medicine, University College London, 3rd Floor East, 250 Euston Road, London, NW1 2PG, UK.
Steve
S
Halligan
Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK.
Christian
C
von Wagner
D000368:Aged; D023881:Colonography, Computed Tomographic / Q000379:methods*; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009780:Occult Blood; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
CT colonography (CTC); Colon cancer; Computed tomography; Endoscopy; Fecal occult blood test