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. 2024 Jul 8;10(14):e34274.
doi: 10.1016/j.heliyon.2024.e34274. eCollection 2024 Jul 30.

Socioeconomic differences in discrepancies between expected and experienced discomfort from colonoscopy and colon capsule endoscopy

Ulrik Deding  1   2 , Henrik Bøggild  3 , Lasse Kaalby  1   2 , Jacob Hjelmborg  4 , Morten Kobaek-Larsen  1   2 , Marianne Kirstine Thygesen  1   2 , Benedicte Schelde-Olesen  1   2 , Thomas Bjørsum-Meyer  1   2 , Gunnar Baatrup  1   2 ; CareForColon2015 study group
Affiliations

Socioeconomic differences in discrepancies between expected and experienced discomfort from colonoscopy and colon capsule endoscopy

Ulrik Deding et al. Heliyon. .

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.

Keywords: Colon capsule endoscopy; Colonoscopy; Colorectal cancer screening; Inequality; Patient discomfort; Socioeconomic status.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Gunnar Baatrup reports financial support was provided by 10.13039/501100004196OUH Innovation Fund. Gunnar Baatrup reports financial support was provided by 10.13039/501100010344Aage og Johanne Louis-Hansens Fond. Gunnar Baatrup reports financial support was provided by The Danish Cancer society. Gunnar Baatrup reports financial support was provided by The 10.13039/100004374Medtronic Research Foundation. Gunnar Baatrup reports financial support was provided by The Region of Southern Denmark's Excellence Centre.

Figures

Fig. 1
Fig. 1
Flow of participants from the 2031 who underwent colon capsule endoscopy in the intervention arm of CareForColon2015 to those eligible for experienced discomfort analyses (green and blue circles), and discomfort discrepancy analyses (yellow circles) *Previous colonoscopy experience (n = 35), educational level (n = 59), household income (n = 302).
Fig. 2
Fig. 2
Median experienced discomfort from each of the five phases included in the overall experienced discomfort VAS score†, stratified by investigation modality and socioeconomic measure.
Fig. 3
Fig. 3
Odds ratios of having a higher discrepancy between expected and experienced overall discomfort from colon capsule endoscopy and colonoscopy based on educational level, estimated from continuous ordinal regression models*. n = 1401 *Adjusted for household income, previous colonoscopy experience, sex, and age.
Fig. 4
Fig. 4
Odds ratios of having a higher discrepancy between expected and experienced overall discomfort from colon capsule endoscopy and colonoscopy based on income, estimated from continuous ordinal regression models *. n = 723 *Adjusted for educational level, previous colonoscopy experience, sex, and age.
See this image and copyright information in PMC

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