Online education linked to less anxiety in colonoscopy

An online education program appeared to dampen anxiety levels in colonoscopy patients and even seemed to reduce the burden of the procedure in terms of time and medication used, a study showed.

“The program was very well received and generally improved patient’s anxiety.” “Only four percent of patients described feeling more anxious after watching the program, whereas 58 percent felt less anxious.”

According to an interview, data about anxiety surrounding colonoscopy are limited. However, worries about various aspects of the procedure, and findings and possible complications, appear to underlie the anxiety.

Patients who are afraid or anxious may require more sedation, experience more pain, and, most importantly, may be less likely to have a procedure done. Some patients don’t schedule at all, while others, may schedule and then cancel last minute or no-show an appointment, which has its own implications and costs to the health care system.

In terms of anxiety prevention, primarily we rely on nurses and doctors to discuss the need for screening and provide reassurance about low risks and real benefits.

For the current study, published in the journal of Clinical Gastroenterology, researchers tested a Web-based colonoscopy education program from a company.     

The program is designed to provide about the colonoscopy process. It covers what to expect before, during, and after, the procedure including possible findings (e.g. polyps). It also covers risks and benefits with some tips on recovery after the procedure. I think having some dedicated time to understand the procedure is most helpful. It is rare that a patient gets 15-20 minutes to review any topic with their doctor, and the program has added benefit of visual cues.

The researchers recruited and randomly assigned 52 patients to the intervention. All were scheduled to undergo colonoscopies within at least two weeks.

The groups were similar. Most patients were white (100 percent of the control group, 89 percent of the intervention group), and most were female; the average age was 48 years. The intervention group had more education, at 69 percent with college degrees vs. 43 percent in the control group. (P = .01).

Patients in the control group received usual colonoscopy education materials, while those in the intervention group were also directed to the education website.

All participants took a survey immediately before their procedures and received a $10 gift card as reimbursement for their participation.

Researchers found that patients in the intervention group scored higher than did those in the  control group on questions about colonoscopy knowledge (82 percent of questions correct vs. 74 percent, P less than .001).

Also, the education website may have convinced its viewers to worry less about the procedure and more about its ultimate findings. Compared with the control group, those in the intervention group were more likely to say they were most concerned about the findings (38.5 percent vs. 21.6 percent) and less likely to say they were more concerned about both the findings and the procedure (38.5 percent vs. 56.9 percent). Roughly 20 percent of those in both groups said they were most concerned about the procedure.

Some patients report being more concerned about findings, e.g. cancer, before the program but more anxious about complications after the program. I think that is a reasonable outcome, as asymptomatic patients should have very little concern about findings, given the goal is to find and remove polyps.

Researchers also tracked the use of sedatives during the procedure. Those in the intervention group required less midazolam (Versed)(average dose of 3.66 mg vs. 4.46 mg, P = .004). They also required less fentanyl (164 mcg. vs. 186 mcg), but this finding was not statistically significant (p = .063).

“There was also a trend, not quite statistically significant, to improved prep quality. (In the intervention vs. the control group, 96 percent vs. 88 percent of subjects were rated as good or excellent in terms of prep quality, P = .27).

The researchers reported study limitations such as multiple endoscopists and sedation nurses and variations in education levels of the participants. The cost of the interactive program was not available.