title: Information seeking and anxiety among colonoscopy-naïve adults: Direct-to-colonoscopyvstraditional consult-first pathways.
abstract: OBJECTIVE
  To investigate the effects of direct to colonoscopy pathways on information seeking behaviors and anxiety among colonoscopy-naïve patients.
  
  
  METHODS
  Colonoscopy-naïve patients at two tertiary care hospitals completed a survey immediately prior to their scheduled outpatient procedure and before receiving sedation. Survey items included clinical pathway (direct or consult), procedure indication (cancer screening or symptom investigation), telephone and written contact from the physician endoscopist office, information sources, and pre-procedure anxiety. Participants reported pre-procedure anxiety using a 10 point scale anchored by "very relaxed" (1) and "very nervous" (10). At least three months following the procedure, patient medical records were reviewed to determine sedative dose, procedure indications and any adverse events. The primary comparison was between the direct and consult pathways. Given the very different implications, a secondary analysis considering the patient-reported indication for the procedure (symptoms or screening). Effects of pathway (directvsconsult) were compared both within and between the screening and symptom subgroups.
  
  
  RESULTS
  Of 409 patients who completed the survey, 34% followed a direct pathway. Indications for colonoscopy were similar in each group. The majority of the participants were women (58%), married (61%), and internet users (81%). The most important information source was family physicians (Direct) and specialist physicians (Consult). Use of other information sources, including the internet (20%vs18%) and Direct family and friends (64%vs53%), was similar in the Direct and Consult groups, respectively. Only 31% of the 81% who were internet users accessed internet health information. Most sought fundamental information such as what a colonoscopy is or why it is done. Pre-procedure anxiety did not differ between care pathways. Those undergoing colonoscopy for symptoms reported greater anxiety [mean 5.3, 95%CI: 5.0-5.7 (10 point Likert scale)] than those for screening colonoscopy (4.3, 95%CI: 3.9-4.7).
  
  
  CONCLUSIONS
  Procedure indication (cancer screening or symptom investigation) was more closely associated with information seeking behaviors and pre-procedure anxiety than care pathway.
authors.affiliation: Jocelyn A Silvester, Harmandeep Kalkat, Lesley A Graff, John R Walker, Harminder Singh, Donald R Duerksen, Faculty of Health Sciences, College of Medicine, University of Manitoba, Winnipeg, MB R2H 2A6, Canada.
authors.forename: Jocelyn A
authors.initials: JA
authors.lastname: Silvester
authors.affiliation: Jocelyn A Silvester, Harmandeep Kalkat, Lesley A Graff, John R Walker, Harminder Singh, Donald R Duerksen, Faculty of Health Sciences, College of Medicine, University of Manitoba, Winnipeg, MB R2H 2A6, Canada.
authors.forename: Harmandeep
authors.initials: H
authors.lastname: Kalkat
authors.affiliation: Jocelyn A Silvester, Harmandeep Kalkat, Lesley A Graff, John R Walker, Harminder Singh, Donald R Duerksen, Faculty of Health Sciences, College of Medicine, University of Manitoba, Winnipeg, MB R2H 2A6, Canada.
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Graff
authors.affiliation: Jocelyn A Silvester, Harmandeep Kalkat, Lesley A Graff, John R Walker, Harminder Singh, Donald R Duerksen, Faculty of Health Sciences, College of Medicine, University of Manitoba, Winnipeg, MB R2H 2A6, Canada.
authors.forename: John R
authors.initials: JR
authors.lastname: Walker
authors.affiliation: Jocelyn A Silvester, Harmandeep Kalkat, Lesley A Graff, John R Walker, Harminder Singh, Donald R Duerksen, Faculty of Health Sciences, College of Medicine, University of Manitoba, Winnipeg, MB R2H 2A6, Canada.
authors.forename: Harminder
authors.initials: H
authors.lastname: Singh
authors.affiliation: Jocelyn A Silvester, Harmandeep Kalkat, Lesley A Graff, John R Walker, Harminder Singh, Donald R Duerksen, Faculty of Health Sciences, College of Medicine, University of Manitoba, Winnipeg, MB R2H 2A6, Canada.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Duerksen
keywords: Anxiety; Colonoscopy/utilization; Direct access colonoscopy; Health care delivery; Information seeking behavior; Referral and consultation