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Reducing mortality from colorectal cancer (CRC) may be achieved by the introduction of population-based screening programs. The aim of the systematic review was to update previous research to determine whether screening for CRC using the fecal occult blood test (FOBT) reduces CRC mortality and to consider the benefits, harms, and potential consequences of screening. We searched eight electronic databases (Cochrane Library, MEDLINE, EMBASE, CINAHL, PsychINFO, AMED, SIGLE, and HMIC). We identified nine articles describing four randomized controlled trials (RCTs) involving over 320,000 participants with follow-up ranging from 8 to 18 yr. The primary analyses used intention to screen and a secondary analysis adjusted for nonattendance. We calculated the relative risks and risk differences for each trial, and then overall, using fixed and random effects models. Combined results from the four eligible RCTs indicated that screening had a 16% reduction in the relative risk (RR) of CRC mortality (RR 0.84, 95% confidence interval [CI] 0.78-0.90). There was a 15% RR reduction (RR 0.85, 95% CI 0.78-0.92) in CRC mortality for studies that used biennial screening. When adjusted for screening attendance in the individual studies, there was a 25% RR reduction (RR 0.75, 95% CI 0.66-0.84) for those attending at least one round of screening using the FOBT. There was no difference in all-cause mortality (RR 1.00, 95% CI 0.99-1.02) or all-cause mortality excluding CRC (RR 1.01, 95% CI 1.00-1.03). The present review includes seven new publications and unpublished data concerning CRC screening using FOBT. This review confirms previous research demonstrating that FOBT screening reduces the risk of CRC mortality. The results also indicate that there is no difference in all-cause mortality between the screened and nonscreened populations.

Patient experience reflects quality of care from the patients' perspective; therefore, patients' experiences are important data in the evaluation of the quality of health services. The development of an abbreviated, reliable and valid instrument for measuring inpatients' experience would reflect the key aspect of inpatient care from patients' perspective as well as facilitate quality improvement by cultivating patient engagement and allow the trends in patient satisfaction and experience to be measured regularly. The study developed a short-form inpatient instrument and tested its ability to capture a core set of inpatients' experiences. The Hong Kong Inpatient Experience Questionnaire (HKIEQ) was established in 2010; it is an adaptation of the General Inpatient Questionnaire of the Care Quality Commission created by the Picker Institute in United Kingdom. This study used a consensus conference and a cross-sectional validation survey to create and validate a short-form of the Hong Kong Inpatient Experience Questionnaire (SF-HKIEQ). The short-form, the SF-HKIEQ, consisted of 18 items derived from the HKIEQ. The 18 items mainly covered relational aspects of care under four dimensions of the patient's journey: hospital staff, patient care and treatment, information on leaving the hospital, and overall impression. The SF-HKIEQ had a high degree of face validity, construct validity and internal reliability. The validated SF-HKIEQ reflects the relevant core aspects of inpatients' experience in a hospital setting. It provides a quick reference tool for quality improvement purposes and a platform that allows both healthcare staff and patients to monitor the quality of hospital care over time.

ObjectivesMeasuring patient experience of gastrointestinal (GI) procedures is a key component of evaluation of quality of care. Current measures of patient experience within GI endoscopy are largely clinician derived and measured; however, these do not fully represent the experiences of patients themselves. It is important to measure the entirety of experience and not just experience directly during the procedure. We aimed to develop a patient-reported experience measure (PREM) for GI procedures.DesignPhase 1: semi-structured interviews were conducted in patients who had recently undergone GI endoscopy or CT colonography (CTC) (included as a comparator). Thematic analysis identified the aspects of experience important to patients. Phase 2: a question bank was developed from phase 1 findings, and iteratively refined through rounds of cognitive interviews with patients who had undergone GI procedures, resulting in a pilot PREM. Phase 3: patients who had attended for GI endoscopy or CTC were invited to complete the PREM. Psychometric properties were investigated. Phase 4 involved item reduction and refinement.ResultsPhase 1: interviews with 35 patients identified six overarching themes: anxiety, expectations, information & communication, embarrassment & dignity, choice & control and comfort. Phase 2: cognitive interviews refined questionnaire items and response options. Phase 3: the PREM was distributed to 1650 patients with 799 completing (48%). Psychometric properties were found to be robust. Phase 4: final questionnaire refined including 54 questions assessing patient experience across five temporal procedural stages.ConclusionThis manuscript gives an overview of the development and validation of the Newcastle ENDOPREM™, which assesses all aspects of the GI procedure experience from the patient perspective. It may be used to measure patient experience in clinical care and, in research, to compare patients’ experiences of different endoscopic interventions.

Objectives To describe the level of overdetection people would find acceptable in screening for breast, prostate, and bowel cancer and whether acceptability is influenced by the magnitude of the benefit from screening and the cancer specific harms from overdetection. Design Online survey. Women were presented with scenarios on breast and bowel cancer, men with scenarios on prostate and bowel cancer. For each particular cancer, we presented epidemiological information and described the treatment and its consequences. Secondly, we presented two different scenarios of benefit: one indicating a 10% reduction in cancer specific mortality and the second indicating a 50% reduction. Setting Online survey of the population in the United Kingdom. Participants Respondents were part of an existing panel of people who volunteer for online research and were invited by email or online marketing. We recruited 1000 respondents, representative for age and sex for the UK population. Main outcome measures Number of cases of overdetection people were willing to accept, ranging from 0-1000 (complete screened population) for each cancer modality and each scenario of benefit. Results There was large variability between respondents in the level of overdetection they would find acceptable, with medians ranging from 113 to 313 cases of overdetection per 1000 people screened. Across all scenarios, 4-7% of respondents indicated they would accept no overdetection at all compared with 7-14% who thought that it would be acceptable for the entire screened population to be overdetected. Acceptability in screening for bowel cancer was significantly lower than for breast and prostate cancer. People aged 50 or over accepted significantly less overdetection, whereas people with higher education levels accepted more; 29% of respondents had heard of overdetection before. Conclusions Acceptability of overdetection in cancer screening is variable. Invitations for screening should include clear information on the likelihood and consequences of overdetection to allow people to make an informed choice.

Background Long-term conditions have a significant impact on individuals, their families, and the health service. As people with these conditions represent a high proportion of hospital admissions, investigating their experiences of inpatient care has become an important area of investigation. We conducted a secondary analysis of the NHS adult inpatient survey for England to compare the hospital experiences of three groups of patients: those without long-term conditions, those with a single long-term condition, and those with multiple long-term conditions. We were particularly interested in the extent to which these patients received self-management support from hospital staff, so we developed a brief summary tool drawn from salient questions in the survey to aid the comparison. Methods Analysis of data from the 2011 national adult inpatient survey ( n  = 65,134) to compare the experiences of three groups of patients: those with no limiting long-term conditions (No-LLTC), those with one limiting long-term condition (S-LLTC), and those with two or more limiting long-term conditions (M-LLTC). The main outcome measure was patients’ self-reports of their experience of inpatient care, including staff-patient interactions, information provision, involvement in decisions and support for self-care and overall ratings of care. A short form scale, the Oxford Patient Involvement and Experience scale (OxPIE) was developed from the adult inpatient survey and used to compare the groups using logistic regression. Results There were significant differences between the No-LLTC group in comparison to both the S-LLTC and M-LLTC groups. Patients with limiting long-term conditions reported significantly worse hospital experiences than those without, as measured by OxPIE: S-LLTC odds ratio = 1.23, 95% CI 1.03-1.48; M-LLTC odds ratio = 1.64, 95% CI 1.19 – 2.26. Responses to a single global rating question were more positive but not strongly correlated with OxPIE. Conclusions Patients with LLTCs were more critical of their inpatient care than those with no LLTCs. Those with more than one long-term condition reported worse experiences than those with a single limiting condition. Simple rating questions may not be sufficiently sensitive to reflect important aspects of patients’ experience.

IntroductionGastrointestinal (GI) endoscopy and computed tomography colonography (CTC) are crucial diagnostic and therapeutic procedures. Measuring patient experience of GI procedures allows evaluation of quality of patient care, identification of areas requiring improvement and, hence, helps optimise patient outcomes.1Patient Reported Experience Measures (PREMs) should be patient-derived, however, current measures are clinician derived.2 This study used the patient’s perspective to develop a PREM for GI procedures. #MethodsThe study comprised four phases. Phase 1: –qualitative semi-structured interviews with patients who had recently undergone endoscopy/CTC. Thematic analysis identified important aspects of experience, and determined whether these were similar, or differed, across GI modalities. Phase 2: A draft PREM was developed from the phase 1 analysis and refined by the study team. Further refinement was undertaken in rounds of cognitive interviews with patients. Phase 3: The pilot PREM was prospectively administered, for self-completion, to patients following a GI procedure at four sites in North East England. The psychometric properties of the PREM were investigated. Phase 4: Review and revision.ResultsPhase 1: Six themes were identified from 35 patient interviews: anxiety, expectations, information & communication, embarrassment & dignity, choice &control and comfort. These were seen for colonoscopy, OGD and CTC. Phase 2: Themes were structured by procedural stage (before the procedure, at the hospital, during the procedure, after the procedure). The draft PREM was refined iteratively during five rounds of cognitive interviews with 15 patients. Phase 3: Between October 2017 and September 2018 the pilot PREM was prospectively administered, for self-completion, to 1650 patients. The response rate was 48.4% (n=799). The instrument had good psychometric properties and was found to contain 7 subscales. Phase 4: Redundant questions were removed, some wording was refined, and the questionnaire finalised. The final instrument includes 54 questions.ConclusionsThe Newcastle ENDOPREM™ assesses all aspects of the GI procedure experience. It will be used for measuring patient experience in clinical practice and within endoscopy trials. The PREM is now undergoing international validation.ReferencesRees CJ, et al. BSG position statement on patient experience of GI endoscopy. Gut 2019; DOI: 10.1136/gutjnl-2019-319027Brown S, et al. Patient-derived measures of GI endoscopy: a meta-narrative review of the literature. Gastrointest Endosc 2015;81(5):1130–40

IntroductionGastrointestinal (GI) endoscopy and computed tomography colonoscopy (CTC) are widely performed investigations of the GI tract. Patient experience affects future uptake, attendance for surveillance and correlates with outcomes.1 Current measures of experience are clinician and nurse-derived.2 The Newcastle ENDOPREMTM was developed using a rigorous systematic process based on qualitative patient interviews.3 This study aimed to investigate the psychometric properties of the instrument.MethodsPatients aged ≥18 years, undergoing oesophagogastroduodenoscopy (OGD), colonoscopy or CTC at four sites in North East England were prospectively asked to complete the PREM. Using IBM®SPSS® 24, we examined response rates and patterns, missing values, floor and ceiling effects and item-total correlations. Exploratory factor analysis (EFA) was conducted using principal components analysis. Reliability of factors was assessed using Cronbach’s α.Results799 questionnaires were returned from Oct 2017 – Sept 2018 (response rate 48.4%). Respondents were aged 18–95 years (mean 65.3, SD 12.6), 43.3% were male and 41.1% had undergone OGD, 43.3% colonoscopy and 14.4% CTC. 24 of the 59 questions had a ceiling effect (>40% choosing the ‘best’ response). No questions had floor effects. For three questions, more than 5% of respondents failed to answer. The highest was 8.6%. The mean number of questions missed was 1.2; this was higher in older patients. Eight questions correlated poorly with others (rho<0.3) and were excluded from EFA. EFA showed seven factors, explaining 61.5% of the variance. All factors had Cronbach’s α >0.6, indicating good reliability.3 ConclusionsThe Newcastle ENDOPREMTM has good psychometric properties. This analysis has enabled refinement of some questions and item reduction, resulting in a PREM, derived from patients’ reports, which comprehensively assesses patient experience across GI investigative modalities.ReferencesEkkelenkamp VE, et al. Patient comfort and quality in colonoscopy. World J Gastroenterol 2013;19(15):2355–61Brown S, et al. Patient-derived measures of GI endoscopy: a meta-narrative review of the literature. Gastrointest Endosc 2015;81(5):1130–40Neilson LJ et al. Patient experience of gastrointestinal endoscopy: informing the development of the Newcastle ENDOPREMTM. Frontline Gastroenterol 2020;0:1–9.

BackgroundMeasuring patient experience is important for evaluating the quality of patient care, identifying aspects requiring improvement and optimising patient outcomes. Patient Reported Experience Measures (PREMs) should, ideally, be patient derived, however no such PREMs for gastrointestinal (GI) endoscopy exist. This study explored the experiences of patients undergoing GI endoscopy and CT colonography (CTC) in order to: identify aspects of care important to them; determine whether the same themes are relevant across investigative modalities; develop the framework for a GI endoscopy PREM.MethodsPatients aged ≥18 years who had undergone oesophagogastroduodenoscopy (OGD), colonoscopy or CTC for symptoms or surveillance (but not within the national bowel cancer screening programme) in one hospital were invited to participate in semi-structured interviews. Recruitment continued until data saturation. Inductive thematic analysis was undertaken.Results35 patients were interviewed (15 OGD, 10 colonoscopy, 10 CTC). Most patients described their experience chronologically, and five ‘procedural stages’ were evident: before attending for the test; preparing for the test; at the hospital, before the test; during the test; after the test. Six themes were identified: anxiety; expectations; choice & control; communication & information; comfort; embarrassment & dignity. These were present for all three procedures but not all procedure stages. Some themes were inter-related (eg, expectations & anxiety; communication & anxiety).ConclusionWe identified six key themes encapsulating patient experience of GI procedures and these themes were evident for all procedures and across multiple procedure stages. These findings will be used to inform the development of the Newcastle ENDOPREM™.

Objective To investigate patient experience of CT colonography (CTC) and colonoscopy in a national screening programme. Methods Retrospective analysis of patient experience postal questionnaires. We included screenees from a fecal occult blood test (FOBt) based screening programme, where CTC was performed when colonoscopy was incomplete or deemed unsuitable. We analyzed questionnaire responses concerning communication of test risks, test-related discomfort and post-test pain, as well as complications. CTC and colonoscopy responses were compared using multilevel logistic regression. Results Of 67,114 subjects identified, 52,805 (79 %) responded. Understanding of test risks was lower for CTC (1712/1970 = 86.9 %) than colonoscopy (48783/50975 = 95.7 %, p  < 0.0001). Overall, a slightly greater proportion of screenees found CTC unexpectedly uncomfortable (506/1970 = 25.7 %) than colonoscopy (10,705/50,975 = 21.0 %, p  < 0.0001). CTC was tolerated well as a completion procedure for failed colonoscopy (unexpected discomfort; CTC = 26.3 %: colonoscopy = 57.0 %, p  < 0.001). Post-procedural pain was equally common (CTC: 288/1970,14.6 %, colonoscopy: 7544/50,975,14.8 %; p  = 0.55). Adverse event rates were similar in both groups (CTC: 20/2947 = 1.2 %; colonoscopy: 683/64,312 = 1.1 %), but generally less serious with CTC. Conclusions Even though CTC was reserved for individuals either unsuitable for or unable to complete colonoscopy, we found only small differences in test-related discomfort. CTC was well tolerated as a completion procedure and was extremely safe. CTC can be delivered across a national screening programme with high patient satisfaction. Key Points • High patient satisfaction at CTC is deliverable across a national screening programme. • Patients who cannot tolerate screening colonoscopy are likely to find CTC acceptable. • CTC is extremely safe; complications are rare and almost never serious. • Patients may require more detailed information regarding the expected discomfort of CTC.