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Robert E. Schoen, MD, MPH; Joel L. Weissfeld, MD, MPH; Nancy J. Bowen, DrPH; Galen Switzer, PhD; Andrew Baum, PhD

Arch Intern Med. 2000;160:1790-1796.

Background  Screening flexible sigmoidoscopy is an underused cancer prevention procedure. Physicians often cite patient discomfort as a reason for not requesting sigmoidoscopy, but patient experiences and attitudes toward sigmoidoscopy have not been well studied.

Objective  To measure patient satisfaction and the determinants of satisfaction with screening sigmoidoscopy.

Methods  An instrument to assess satisfaction with screening sigmoidoscopy was developed. Responses were evaluated with a factor analysis, tested for reproducibility and internal consistency, and validated against an external standard.

Results  A total of 1221 patients (666 men and 555 women; mean age, 61.8 years) were surveyed after sigmoidoscopy. Examinations were performed by a nurse practitioner (n=668), internist (n=344), or gastrointestinal specialist (n=184). More than 93% of the participants strongly agreed or agreed they would be willing to undergo another examination, and 74.9% would strongly recommend the procedure to their friends. Regarding pain and discomfort, 76.2% strongly agreed or agreed that the examination did not cause a lot of pain, 78.1% stated that it did not cause a lot of discomfort, and 68.5% thought that it was more comfortable than they expected. Fifteen percent to 25% of the patients indicated they had a lot of pain, great discomfort, or more discomfort than expected. Women were more likely to have significant pain or discomfort than men (adjusted odds ratio, 2.9; 95% confidence interval, 1.9-4.3; P<.001).

Conclusions  Approximately 70% of individuals who undergo screening sigmoidoscopy are satisfied and find the procedure more comfortable than expected, whereas only 15% to 25% find the procedure unpleasant. Physicians should not project discomfort onto patients as a reason for not requesting screening sigmoidoscopy.

From the Departments of Medicine (Drs Schoen, Bowen, and Switzer), Epidemiology (Drs Schoen and Weissfeld), and Psychiatry (Drs Switzer and Baum) and the University of Pittsburgh Cancer Institute (Drs Schoen, Weissfeld, and Baum), University of Pittsburgh, Pittsburgh, Pa.

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