COMFORT: IN THE EYE OF THE BEHOLDER?

Aims:

Patient comfort score is a recognised key performance indicator in the delivery of colonoscopy. Limited data exists regarding the degree of agreement between endoscopy staff and patients regarding comfort level during colonoscopy.

Methods:

Endoscopist and nurse recorded comfort scores were prospectively recorded for each colonoscopy from the endoscopy documentation, and a patient comfort score was completed by the patient in the recovery area using the standard Gloucester comfort scoring system. Results were compared among groups using Pearson's correlation coefficient and a chi square test with a p ≤0.05 considered significant.

Results:

To date,104 patients have been included,61% female (n = 63), and the majority of patients were > 50yrs (mean 59yrs, range 23 – 89yrs, n = 75). 86%(n = 89) were diagnostic procedures and 80%(n = 83) of the procedures were performed by gastroenterologists. The median sedation used was 3 mg of midazolam (0 – 5 mg) and 50mcg of fentanyl (0 – 100mcg). We identified discordance between reported comfort levels between patients, nurses and doctors. Correlation was greatest when comparing nurses and doctors (r = 0.85). Agreement between patients and doctors was moderate at best (r = 0.51), with moderate levels of agreement also noted between patients and nurses (r = 0.55). 38% (n = 40) of patients reported higher levels of discomfort (comfort score ≥3), compared with 25% (n = 26) of doctors (p = 0.05) and 30% of nurses (n = 31) (p = 0.1). Significantly higher doses of sedatives (≥3 mg midazolam) were recorded in these patients with the greatest level of discomfort compared with patients with Glouchester score 1 – 2 (63% [n = 25/40] vs. 40% [n = 26/64], p = 0.03). Comparison of comfort scores according to procedure duration, age, or gender did not reveal significant differences. However, younger patients (n = 29), 31% (n = 9) self-reported higher levels of discomfort, all of whom were female (p = 0.002).

Conclusions:

These results suggest that the perception of procedure related discomfort varies between these three groups, including endoscopists and nurses. This study also highlights the challenge of accurate patient comfort score reporting as a quality performance indicator during colonoscopy.