Promoting Informed Choice of Unsedated Colonoscopy: Patient-Centered Care for a Subgroup of U. S. Veterans

Background In the United States, colonoscopy is usually performed under sedation. In practice, 2.3-7% actually requested unsedated colonoscopy and 1.4% received it because of no escorts. Efforts to increase usage would likely require increased patient counseling and education. Aim We tested the hypothesis that knowledge conveyed by education-a key attribute of patient-centered care-is associated with acceptance of the "non-usual" option. Methods After patients underwent discussions and expressed acceptance of sedated colonoscopy, the pros and cons of and local experience with unsedated colonoscopy were added. The patients who changed from accepting sedated to unsedated colonoscopy and outcomes of their examinations were recorded. Results From January to November 2006, 49 of 176 consecutive patients (28%) changed their choice from sedated to unsedated colonoscopy after being informed of the latter. Forty-eight had satisfactory bowel preparation. Cecal intubation rate was 93.7% (45 of 48). Thirty-six reported good experience and 43, likely to repeat. Cecal intubation, withdrawal, and discharge times were 23.0 +/- 1.4 min, 15.0 +/- 1.0 min, and 5.0 +/- 0.5 min, respectively (n = 45). Ability to communicate with the colonoscopist during and after the examination was the most frequently ranked reason for choosing unsedated colonoscopy. Conclusion Our uncontrolled, non-randomized, single-site observational data revealed that for selected veterans, acceptance of unsedated colonoscopy coincides with knowledge of the option dispensed by patient counseling and education.