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CC BY 4.0 · Endoscopy 2025; 57(06): 645-657
DOI: 10.1055/a-2528-5578
Original article

Clinician-reported Gloucester Comfort Scale scores underestimate patient discomfort and pain during colonoscopy: insights from comparison with a patient-reported experience measure

Querijn N. E. van Bokhorst
1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location VU Medical Center, Amsterdam, Netherlands
2   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands (Ringgold ID: RIN571165)
3   Cancer Center Amsterdam, Amsterdam, Netherlands
,
Charmayne V. Geerlings
1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location VU Medical Center, Amsterdam, Netherlands
,
Manon van der Vlugt
1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location VU Medical Center, Amsterdam, Netherlands
2   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands (Ringgold ID: RIN571165)
3   Cancer Center Amsterdam, Amsterdam, Netherlands
4   Department of Gastroenterology, Bergman Clinics, Amsterdam, Netherlands
,
Karlijn J. Nass
5   Department of Internal Medicine, Rijnstate Hospital, Arnhem, Netherlands (Ringgold ID: RIN1322)
,
Jos W. Borkent
6   Lectorate for Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, Netherlands (Ringgold ID: RIN6032)
,
Laura J. Neilson
7   Department of Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, South Shields, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN7413)
8   Faculty of Medical Sciences, Newcastle University Population Health Sciences Institute, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN151476)
,
Paul Fockens
1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location VU Medical Center, Amsterdam, Netherlands
2   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands (Ringgold ID: RIN571165)
3   Cancer Center Amsterdam, Amsterdam, Netherlands
,
Colin J. Rees
7   Department of Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, South Shields, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN7413)
8   Faculty of Medical Sciences, Newcastle University Population Health Sciences Institute, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN151476)
,
Evelien Dekker 
1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location VU Medical Center, Amsterdam, Netherlands
2   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands (Ringgold ID: RIN571165)
3   Cancer Center Amsterdam, Amsterdam, Netherlands
4   Department of Gastroenterology, Bergman Clinics, Amsterdam, Netherlands
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Abstract

Background

Patient experience is a fundamental element of colonoscopy. The Gloucester Comfort Scale (GCS) is used by clinicians to report patient comfort. However, insights regarding the extent to which clinician-reported GCS scores represent the patient’s experience are lacking. We assessed the level of agreement between clinician-reported GCS scores and patient-reported discomfort and pain.

Methods

Consecutive patients undergoing colonoscopy at two Dutch endoscopy clinics were included. Patient comfort during colonoscopy was reported using the GCS (1–5 scale). Patients’ colonoscopy experiences were assessed using the Newcastle ENDOPREM, a validated endoscopy patient-reported experience measure (PREM). Patients reported both discomfort and pain levels experienced during colonoscopy on a 1–5 scale. Levels of agreement were assessed using Cohen’s kappa statistic.

Results

For 243 included patients, the GCS score was higher than the PREM discomfort score in 52 patients (21%) and lower in 72 (30%). GCS score was higher than the PREM pain score in 39 patients (16%) and lower in 71 (29%). Moderate-to-severe discomfort and pain (scores ≥3) were reported by 53 patients (22%) for discomfort and 60 patients (25%) for pain. For these patients, the GCS underestimated discomfort and pain levels in almost all cases (discomfort 49/53 [92%], pain 54/60 [90%]). Agreement between GCS scores and PREM discomfort and pain scores were minimal (Cohen’s κ 0.34) and weak (Cohen’s κ 0.47), respectively.

Conclusions

Clinician-reported GCS scores frequently underestimated the level of discomfort and pain reported by patients. For accurate monitoring of patients’ colonoscopy experiences, the use of PREMs should be considered.

Supplementary Material



Publikationsverlauf

Eingereicht: 17. September 2024

Angenommen nach Revision: 26. Januar 2025

Accepted Manuscript online:
29. Januar 2025

Artikel online veröffentlicht:
28. Februar 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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