Patient preferences and factors related to the pre-procedure process at a large, urban county hospital

Lukejohn W. Day, Michelle Nazareth, Justin L. Sewell

Division of Gastroenterology, San Francisco General Hospital and Trauma Center, San Francisco, USA.
Gastroenterology Division, Department of Medicine, University of California, San Francisco, USA.

DOI: 10.4236/ojgas.2013.31002                

Abstract

Background: Evaluation of the pre-procedural process prior to endoscopic procedures has never been conducted. Methods: Prospective cross-sectional, multi-language survey was administered to outpatients undergoing endoscopy at a large, diverse county hospital that examined patients’ pre-procedural preferences. Multivariate logistic regression was used to assess the relationship between patient preferences and several patient-related variables. Results: 128/156 outpatients completed the survey. The majority of respondents were female (53.1%), did not speak English (61.7%), were of Asian (39.1%) or Hispanic (29.7%) racial background, and had a mean age of 56.1 ± 15.7 years. Most patients underwent colonoscopy (48.4%) with 90.6% of patients knowing the indication for their procedure. While waiting for their endoscopic procedure, 42.2% of patients preferred waiting in a gurney while 28.1% preferred to wait in a chair. In terms of being comfortable wearing a hos- pital gown and sitting in a chair or gurney in the pre-procedure area, mean patient anxiety scores were 5.2 ± 3.3 and 6.1 ± 3.2, respectively (scale of 1 - 10). Race was associated with several pre-procedural patient preferences; Hispanics were less comfortable than Asians wearing a hospital gown while sitting in a chair with other patients prior to their procedure (OR = 0.3, CI 0.1 - 1.0) while Whites and African-Americans were less likely than Asians to prefer sitting in a chair as compared to a gurney before their procedure (OR = 0.09, CI 0.008 - 0.9 and OR = 0.07, CI 0.007 - 0.8, respectively). Patients who had undergone a prior endoscopic procedure were less comfortable wearing a hospital gown and sitting in a chair (OR = 0.3, CI 0.1 - 0.7) or gurney (OR = 0.4, CI 0.2 - 1.0) in the pre-procedure area. Conclusion: A patient’s race and having had a prior endoscopic procedure were the most powerful predictors on pre-procedure patient preferences while sex, type of endoscopic procedure and patient knowledge of the indication for their procedure were not. Our study highlights the importance of patient preferences and factors involved in the pre procedure process at a large, diverse county hospital.

Keywords

Pre-Procedure Process; Quality; Endoscopy; Patient Preferences

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Fidler, H., Hartnett A., Cheng, M.K., Derbyshire, I. and Sheil, M. (2000) Sex and familiarity of colonoscopists: Patient preferences. Endoscopy, 32, 481-482. doi:10.1055/s-2000-645
[2]	Varadarajulu, S., Petruff, C. and Ramsey, W.H. (2002) Patient preferences for gender of endoscopists. Gastrointestinal Endoscopy, 56, 170-173. doi:10.1016/S0016-5107(02)70173-9
[3]	Schneider, A., Kanagarajan, N., Anjelly, D., Reynolds, J.C. and Ahmad, A. (2009) Importance of gender, socioeconomic status, and history of abuse on patient preference for endoscopist. American Journal of Gastroenterology, 104, 340-348. doi:10.1038/ajg.2008.96
[4]	Subramanian, S., Liangpunsakul, S. and Rex, D.K. (2005) Preprocedure patient values regarding sedation for colonoscopy. Journal of Clinical Gastroenterol, 39, 516-519. doi:10.1097/01.mcg.0000165667.79530.44
[5]	Chartier, L., Arthurs, E. and Sewitch, M.J. (2009) Patient satisfaction with colonoscopy: A literature review and pilot study. Canadian Journal of Gastroenterology, 23, 203-209.
[6]	Kowalski, T., Edmundowicz, S. and Vacante, N. (2004) Endoscopy unit form and function. Gastrointestinal Endoscopy Clinics of North America, 14, 657-666. doi:10.1016/j.giec.2004.04.006
[7]	Marasco, J.A. and Marasco, R.F. (2002) Designing the ambulatory endoscopy center. Gastrointestinal Endosco py Clinics of North America, 12, 185-204. doi:10.1016/S1052-5157(01)00002-2
[8]	Petersen, B.T. (2006) Promoting efficiency in gastrointestinal endoscopy. Gastrointestinal Endoscopy Clinics of North America, 16, 671-685. doi:10.1016/j.giec.2006.08.011
[9]	SGNA Position Statement (2002) Minimal registered nurse staffing for patient care in the gastrointestinal endoscopy unit. Gastroenterology Nursing, 25, 269-270.
[10]	Al-Kawas, F.H. and Brugge, W.R. (2008) Report of the first endoscopy unit directors meeting: March 29-30, 2008, Georgetown University Conference Center, Washington DC. Gastrointestinal Endoscopy, 68, 1153-1157. doi:10.1016/j.gie.2008.07.050
[11]	Harewood, G.C., Chrysostomou, K., Himy, N. and Leong, W.L. (2008) A “time-and-motion” study of endoscopic practice: Strategies to enhance efficiency. Gastrointestinal Endoscopy, 68, 1043-1050. doi:10.1016/j.gie.2008.03.1116
[12]	Johanson, J.F., Overholt, B.F. and Frakes, J.T. (1999) Characteristics of best gastroenterology practices. American Journal of Gastroenterology, 94, 2519-2530. doi:10.1111/j.1572-0241.1999.01387.x
[13]	Brandt, L.J. (2001) Patients’ attitudes and apprehensions about endoscopy: How to calm troubled waters. American Journal of Gastroenterology, 96, 280-284.
[14]	Johnson, J.E., Morrissey, J.F. and Leventhal, H. (1973) Psychological preparation for an endoscopic examination. Gastrointestinal Endoscopy, 19, 180-182. doi:10.1016/S0016-5107(73)73995-X
[15]	Hayes, A., Buffum, M., Lanier, E., Rodahl, E. and Sasso, C. (2003) A music intervention to reduce anxiety prior to gastrointestinal procedures. Gastroenterology Nursing, 26, 145-149. doi:10.1097/00001610-200307000-00002
[16]	Salmore, R.G. and Nelson, J.P. (2000) The effect of preprocedure teaching, relaxation instruction, and music on anxiety as measured by blood pressures in an outpatient gastrointestinal endoscopy laboratory. Gastroenterology Nursing, 23, 102-110. doi:10.1097/00001610-200005000-00003
[17]	Bechtold, M.L., Puli, S.R., Othman, M.O., Bartalos, C.R., Marshall, J.B. and Roy, P.K. (2009) Effect of music on patients undergoing colonoscopy: A meta-analysis of randomized controlled trials. Digestive Diseases and Sciences, 54, 19-24. doi:10.1007/s10620-008-0312-0
[18]	El-Hassan, H., McKeown, K. and Muller, A.F. (2009) Clinical trial: Music reduces anxiety levels in patients attending for endoscopy. Alimentary Pharmacology & Therapeutics, 30, 718-724. doi:10.1111/j.1365-2036.2009.04091.x
[19]	Inadomi, J.M., Vijan, S., Janz, N.K., et al. (2012) Adherence to colorectal cancer screening: a randomized clinical trial of competing strategies. Archives of Internal Medicine, 172, 575-582. doi:10.1001/archinternmed.2012.332
[20]	Schoenfelder, T., Klewer, J. and Kugler J. (2010) Factors associated with patient satisfaction in surgery: The role of patients’ perceptions of received care, visit characteristics, and demographic variables. Journal of Surgical Research, 164, e53-e59. doi:10.1016/j.jss.2010.08.001