Open access colonoscopy in the training setting: Which factors affect patient satisfaction and pain?

Background and study aim: Patient satisfaction with colonoscopy is important for quality assurnce; it may be affected by various factors, including patient characteristics, physician training level, and procedural or organizational features. We aimed to analyze how these factors influenced patient satisfaction and pain in an outpatient training setting. Methods: Consecutive patients for open access colonoscopy (OAC) were enrolled in a prospective, single-blinded, controlled study. Primary and secondary outcomes were satisfaction and pain scores with and without trainee participation. A multivariate analysis was designed to achieve an 80% power with an alpha value of 0.05. Results: 368 patients were enrolled. Satisfaction with the procedure was high (mean score 1.36; 1 = best to 5 = worst). In the multivariate analysis only waiting time in the endoscopy suite was significantly associated with lower satisfaction scores (P= 0.024). Satisfaction was unaffected by patient factors (gender, American Society of Ansthesiologists' [ASA] score, anxiety, etc). Higher pain scores were associated with higher anxiety levels (P= 0.02), female gender (P= 0.02), longer procedure (P < 0.001), and lower sedation levels (P= 0.001); trainee involvement (49% of procedures) did not adversely affect satisfaction or pain scores. Conclusions: Patient satisfaction with OAC using sedation appears to depend primarily on organizational factors (waiting time beforehand). In contrast pain is associated with patient characteristics (female gender, anxiety) and procedural factors (lower sedation, longer procedure). Trainee participation did not affect satisfaction or pain scores, a finding which may help to reassure patients undergoing OAC with trainee participation.