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,” said lead author Siddhartha Parker, MD, a gastroenterologist at Dartmouth-Hitchcock Medical Center, Lebanon, N.H. “Only 4% of patients described feeling more anxious after watching the program whereas 58% felt less anxious.”
Dr. Siddhartha Parker
“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,” he said. “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, he said, “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 called Emmi Solutions.
The program is designed to provide details about the colonoscopy process. “It covers what to expect before, during, and after the procedure including possible findings (e.g., polyps),” Dr. Parker said. “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 Emmi program has the added benefit of visual cues.”
The researchers recruited and randomly assigned 51 patients to a control group and 52 patients to the intervention. All were scheduled to undergo colonoscopies within at least 2 weeks.
The groups were similar: Most patients were white (100% of the control group, 89% of the intervention group), and most were female; the average age was 48 years The intervention group had more education, at 69% with college degrees vs. 43% 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% of questions correct vs. 74%, 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% vs. 21.6%) and less likely to say they were more concerned about both the findings and the procedure (38.5% vs. 56.9%). Roughly 20% 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,” Dr. Parker said. “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,” Dr. Parker said. (In the intervention vs. the control group, 96% vs. 88% of subjects were rated as good or excellent in terms of prep quality, P = .27).
“This is important because a poor or inadequate prep leads to a need for a repeat procedure to ensure adequate screening,” he said. “If prep quality improves, that means fewer unnecessary repeated procedures.”
The researchers reported study limitations such as multiple endoscopists and sedation nurses and the variation in education levels of the participants.
The cost of the interactive program was not available.
According to Dr. Parker, Dartmouth-Hitchcock Medical Center now offers the education program to all colonoscopy patients, and a modified version is available for those undergoing upper endoscopies.
“Not all patients have adequate computer resources, and some patients simply choose not to watch,” he said. “But my impression is that those who watched the program are more relaxed during the informed consent process. However, we are not actively tracking outcomes such as procedure time or medication usage.”
No more studies of the program are planned at the institution, he said.
One of the study authors is an employee of Emmi Solutions, which provided the program for free for use in the study. The other authors reported no relevant disclosures. No study funding was reported.
SOURCE: Parker S et al. J Clin Gastroenterol. doi: 10.1097/MCG.0000000000000958