Socioeconomic Differences in Discrepancies Between Expected and Experienced Discomfort from Colonoscopy and Colon Capsule Endoscopy

Overview

Journal Heliyon

Specialty Social Sciences

Date 2024 Aug 5

PMID 39100485

Authors

Ulrik Deding

Henrik Boggild

Lasse Kaalby

Jacob Hjelmborg

Morten Kobaek-Larsen

Marianne Kirstine Thygesen

Benedicte Schelde-Olesen

Thomas Bjorsum-Meyer

Gunnar Baatrup

Affiliations

Soon will be listed here.

Abstract

Background: Social inequalities in colorectal cancer screening participation are evident. Barriers to screening participation include discomfort from diagnostic modalities. We aimed to describe the discomfort experienced from colonoscopy and colon capsule endoscopy (CCE) and investigate the discrepancy between expected and experienced discomfort stratified by socioeconomic status.

Methods: A randomised controlled trial was conducted offering half of the colorectal cancer screening invitees the choice between CCE and colonoscopy after a positive faecal immunochemical test. This paper includes those who elected to undergo CCE. A positive CCE elicited referral for a therapeutic colonoscopy. Participants reported their discomfort from CCE and from any following colonoscopies in electronically distributed questionnaires. Discomfort was measured using visual analogue scales and compared between socioeconomic subgroups determined by educational level and income.

Results: The experienced discomfort from CCE and colonoscopy differed significantly between educational levels but not income levels. The bowel preparation contributed the most to the experienced discomfort in both CCE and colonoscopy. The discrepancy between expected and experienced discomfort from colonoscopy increased with increasing educational and income levels. A similar trend was seen in CCE between educational levels but not income levels.

Conclusions: None of the results indicated a higher discomfort in lower socioeconomic subgroups. Regardless of the investigation modality, the bowel preparation was the main contributor to experienced discomfort. The discrepancy between expected and experienced discomfort did not seem to be larger in lower socioeconomic subgroups, indicating that this is not a major barrier causing inequalities in screening uptake. This is the first study investigating individual discomfort discrepancy in both CCE and colonoscopy, while being able to stratify by socioeconomic status.

References

Manuguerra M, Heller G . Ordinal regression models for continuous scales. Int J Biostat. 2011; 6(1):Article 14. DOI: 10.2202/1557-4679.1230. View

Ghanouni A, Plumb A, Hewitson P, Nickerson C, Rees C, Von Wagner C . Patients' experience of colonoscopy in the English Bowel Cancer Screening Programme. Endoscopy. 2016; 48(3):232-40. DOI: 10.1055/s-0042-100613. View

Von Wagner C, Bonello B, Stoffel S, Skrobanski H, Freeman M, Kerrison R . Barriers to bowel scope (flexible sigmoidoscopy) screening: a comparison of non-responders, active decliners and non-attenders. BMC Public Health. 2018; 18(1):1161. PMC: 6173878. DOI: 10.1186/s12889-018-6071-8. View

Nielsen J, Berg-Beckhoff G, Leppin A . To do or not to do - a survey study on factors associated with participating in the Danish screening program for colorectal cancer. BMC Health Serv Res. 2021; 21(1):43. PMC: 7792101. DOI: 10.1186/s12913-020-06023-6. View

Deding U, Kaalby L, Baatrup G, Kobaek-Larsen M, Thygesen M, Epstein O . The Effect of Prucalopride on the Completion Rate and Polyp Detection Rate of Colon Capsule Endoscopies. Clin Epidemiol. 2022; 14:437-444. PMC: 8985819. DOI: 10.2147/CLEP.S353527. View

Honein-AbouHaidar G, Kastner M, Vuong V, Perrier L, Daly C, Rabeneck L . Systematic Review and Meta-study Synthesis of Qualitative Studies Evaluating Facilitators and Barriers to Participation in Colorectal Cancer Screening. Cancer Epidemiol Biomarkers Prev. 2016; 25(6):907-17. DOI: 10.1158/1055-9965.EPI-15-0990. View

Deding U, Henig A, Salling A, Torp-Pedersen C, Boggild H . Sociodemographic predictors of participation in colorectal cancer screening. Int J Colorectal Dis. 2017; 32(8):1117-1124. DOI: 10.1007/s00384-017-2832-6. View

Dolatkhah R, Somi M, Dastgiri S, Jafarabadi M, Sepehri B, Shirmohammadi M . Identifying the main barriers for participation in a population-based colorectal cancer screening programme in East Azerbaijan, Iran. Ecancermedicalscience. 2022; 16:1354. PMC: 9023306. DOI: 10.3332/ecancer.2022.1354. View

Zhang J, Cheng Z, Ma Y, He C, Lu Y, Zhao Y . Effectiveness of Screening Modalities in Colorectal Cancer: A Network Meta-Analysis. Clin Colorectal Cancer. 2017; 16(4):252-263. DOI: 10.1016/j.clcc.2017.03.018. View

10.

Koivogui A, Levi S, Finkler M, Lewkowicz S, Gombeaud T, Sabate J . Feasibility of encouraging participation in colorectal cancer screening campaigns by motivating people through the social network, Facebook. Colorectal Dis. 2020; 22(10):1325-1335. DOI: 10.1111/codi.15121. View

11.

Mosquera I, Mendizabal N, Martin U, Bacigalupe A, Aldasoro E, Portillo I . Inequalities in participation in colorectal cancer screening programmes: a systematic review. Eur J Public Health. 2020; 30(3):416-425. DOI: 10.1093/eurpub/ckz236. View

12.

Deding U, Boggild H, Baatrup G, Kaalby L, Hjelmborg J, Thygesen M . Socioeconomic differences in expected discomfort from colonoscopy and colon capsule endoscopy. Prev Med. 2023; 173:107593. DOI: 10.1016/j.ypmed.2023.107593. View

13.

Shaukat A, Levin T . Current and future colorectal cancer screening strategies. Nat Rev Gastroenterol Hepatol. 2022; 19(8):521-531. PMC: 9063618. DOI: 10.1038/s41575-022-00612-y. View

14.

Libby G, Bray J, Champion J, Brownlee L, Birrell J, Gorman D . Pre-notification increases uptake of colorectal cancer screening in all demographic groups: a randomized controlled trial. J Med Screen. 2011; 18(1):24-9. DOI: 10.1258/jms.2011.011002. View

15.

Waldmann E, Penz D, Majcher B, Zagata J, Sinkovec H, Heinze G . Impact of high-volume, intermediate-volume and low-volume bowel preparation on colonoscopy quality and patient satisfaction: An observational study. United European Gastroenterol J. 2019; 7(1):114-124. PMC: 6374837. DOI: 10.1177/2050640618809842. View

16.

Doubeni C, Laiyemo A, Major J, Schootman M, Lian M, Park Y . Socioeconomic status and the risk of colorectal cancer: an analysis of more than a half million adults in the National Institutes of Health-AARP Diet and Health Study. Cancer. 2012; 118(14):3636-44. PMC: 3422782. DOI: 10.1002/cncr.26677. View

17.

de Klerk C, Gupta S, Dekker E, Essink-Bot M . Socioeconomic and ethnic inequities within organised colorectal cancer screening programmes worldwide. Gut. 2017; 67(4):679-687. DOI: 10.1136/gutjnl-2016-313311. View

18.

Kaalby L, Deding U, Kobaek-Larsen M, Havshoi A, Zimmermann-Nielsen E, Thygesen M . Colon capsule endoscopy in colorectal cancer screening: a randomised controlled trial. BMJ Open Gastroenterol. 2020; 7(1). PMC: 7326244. DOI: 10.1136/bmjgast-2020-000411. View

19.

Randel K, Schult A, Botteri E, Hoff G, Bretthauer M, Ursin G . Colorectal Cancer Screening With Repeated Fecal Immunochemical Test Versus Sigmoidoscopy: Baseline Results From a Randomized Trial. Gastroenterology. 2020; 160(4):1085-1096.e5. DOI: 10.1053/j.gastro.2020.11.037. View

20.

Gini A, Jansen E, Zielonke N, Meester R, Senore C, Anttila A . Impact of colorectal cancer screening on cancer-specific mortality in Europe: A systematic review. Eur J Cancer. 2020; 127:224-235. DOI: 10.1016/j.ejca.2019.12.014. View