A survey of patients' attitudes to upper gastrointestinal endoscopy identifies the value of endoscopist-patient interactive factors

Is There a Need to Undertake Conventional Gastroscopy and Biopsy When Making the Diagnosis of Coeliac Disease in Adults?

Celiac disease is a common autoimmune condition characterized by small intestinal inflammation and mucosal damage triggered by an inappropriate immune response to ingested gluten. Gastroscopy and duodenal biopsy are currently the gold standard approach to diagnosing celiac disease in adults. However, the emergence of highly accurate serological tests for celiac disease in the last 2 decades led to a change in the pediatric guidelines to diagnose celiac disease without biopsy in selected patients. Adopting this no-biopsy approach to diagnose celiac disease in adults remains controversial, but the evidence supporting it is growing.

Patient Education Regarding Fasting Recommendations to Shorten Fasting Times in Patients Undergoing Esophagogastroduodenoscopy: A Controlled Pilot Study

This study evaluated the applicability and efficacy of patient education regarding fasting recommendations to shorten fasting times in patients undergoing esophagogastroduodenoscopy (EGD). A prospective nonrandomized controlled pilot study was performed. The intervention group (IG) was educated by nurses to eat until 6 hours and drink until 2 hours before EGD. The control group (CG) received usual care. Outcomes were applicability as perceived by patients, adherence to fasting recommendations, gastric visibility, and patients' comfort. A total of 109 patients were included of whom 42 were IG patients (37%). Patients' perspectives on fasting, their experienced discomfort, professional support, and circadian rhythm influenced application of fasting recommendations. Adherence to length of fasting from foods improved with 3:14 hours ( p < .001) and from liquids with 5:22 hours ( p < .001) in the IG compared with the CG. Gastric visibility during EGD was better in the IG than in the CG. The IG patients experienced significant less thirst, hunger, headache, and anxiety. To successfully reduce fasting times, fasting education should include positive, individual instructions, which help patients apply the fasting recommendations within their biorhythm. Positive, concrete instructions by nurses shortened fasting times before EGD, which improved gastric visibility and reduced patient discomfort.

Progress in the serology-based diagnosis and management of adult celiac disease

Introduction: This article provides a comprehensive overview of the development and application of serological tests used routinely in clinical practice for the diagnosis and management of adult celiac disease.Areas covered: We summarize existing scientific literature related to anti-endomyseal, anti-tissue transglutaminase, and anti-deamidated gliadin peptide antibodies and detail the current and potential future applications of these tests in celiac disease.Expert commentary: Current serological tests in celiac disease have some of the best performance characteristics among disease-specific tests. However, in adult celiac disease, current diagnostic algorithms still rely on duodenal biopsies to confirm the diagnosis. A 'biopsy avoidance strategy' has been implemented in pediatric celiac disease. Future high-quality studies will help inform on whether this approach can be implemented into adult gastroenterology services. It is envisaged that the next 5 years will see an increasing reliance on serology in the diagnosis of adult celiac disease.

What do patients want from their endoscopy experience? The importance of measuring and understanding patient attitudes to their care

Understanding and addressing patient attitudes to their care facilitates their engagement and attendance, improves the quality of their experience and the appropriate utilisation of resources. Gastrointestinal endoscopy is a commonly performed medical procedure that can be associated with patient anxiety and apprehension. Measuring patient attitudes to endoscopy can be undertaken through a number of approaches with contrasting benefits and limitations. Methodological validation is necessary for accurate interpretation of results and avoiding bias. Retrospective post-procedure questionnaires measuring satisfaction are easily undertaken but have limited value, particularly in directing service improvements. Patient experience questionnaires indicate areas of poor care but may reflect the clinician's not the patient's perspective. Directly assessing patient priorities and expectations identifies what is important to patients in their healthcare experience (patient-reported value) that can also provide a basis for other forms of evaluation. Published studies of patient attitudes to their endoscopy procedure indicate the importance of ensuring that endoscopists and their staff control patient discomfort, have adequate technical skill and effectively communicate with their patient relating to the procedure and results. Environmental factors, including noise, privacy and the single-sex environment, are considered to have less value. There are contrasting views on patient attitudes to waiting times for the procedure. Implementing patient-centred care in endoscopy requires an understanding of what patients want from their healthcare experience. The results from available studies suggest implications for current practice that relate to the training and practice of the endoscopist and their staff.

An evaluation of patient attitudes to colonoscopy and the importance of endoscopist interaction and the endoscopy environment to satisfaction and value

OBJECTIVE

Understanding patients' attitudes to their medical experience is essential for identifying value in the patient pathway, optimizing care and use of resources. This service evaluation was undertaken to determine patients' preferences and expectations for day case colonoscopy, a common gastrointestinal procedure for which there is limited such data.

METHODS

Patients attending for elective colonoscopy were invited to complete a composite, validated dedicated endoscopy questionnaire, with Likert-scale questions and a 15-point preference (ranking) scale of domains of endoscopy care that were considered most important (1) to least important (15) as contributing to a satisfactory experience.

RESULTS

Two hundred and sixteen out of 224 patients returned questionnaires. Moderate to severe anxiety was recorded in 56% of patients, commonly with respect to anticipation of pain or the results of the procedure. The median values for ranked preference scores consistent with greatest importance for satisfaction were technical skill of the endoscopist (1), discomfort during the procedure (4), and manner of the endoscopist (5). Factors considered of relatively low importance included the single-sex environment (15) (although this was more important to female patients), noise levels (13), and explanation of delay (11). Only 14% of patients responded that they would be prepared to delay an appointment for a single-sex environment.

CONCLUSION

Patients undergoing colonoscopy highly prioritize aspects of care relating to the interaction with the endoscopist and the procedure itself. Environment factors are considered to be less important. These findings may assist in service redesign around patient-identified value within the patient pathway.

An evaluation of patient attitudes to the gastroenterology outpatient experience

OBJECTIVE

To determine patient attitudes in gastroenterology outpatient care, including the preferences and expectations associated with satisfaction, waiting times and quality in the consultation.

METHODS

A service evaluation of patient care in outpatient gastroenterology clinics was carried out using a composite, dedicated self-completed questionnaire; this included demographics, preconsultation and postconsultation Likert scale attitudes to process, interactive and environmental factors and a 16-point ranking questionnaire of domains of the patient pathway considered important to obtaining satisfaction.

RESULTS

Two hundred and twenty-seven patients agreed to participate. The factors considered most important to obtaining satisfaction related to the quality of the consultation, including 'seeing the doctor', 'having confidence in the treatment plan', 'clear and appropriately set explanations', 'being listened to', 'opportunity to express important issues' and 'recognition of needs'. Low importance was attributed to process and environmental aspects including waiting times (appointment and waiting room), explanations for delays and the quietness and privacy of the consultation room, and involvement of the patient's next of kin. Patients reported dissatisfaction with long waiting times and short consultation times, but this did not appear to influence postconsultation satisfaction, the likelihood of reattendance or following the treatment plan.

CONCLUSION

Patients consider that factors most important to a satisfactory experience in gastroenterology outpatient care relate specifically to the quality of their interaction with their healthcare professional in consultation. The roles of environmental and process issues are considered less important.