Patient preferences for CT colonography, conventional colonoscopy, and bowel preparation

OBJECTIVES: The aim of this study was to determine patient pre-examination expectations and postexamination appraisals for CT colonography, conventional colonoscopy and bowel preparation. METHODS: Prospective evaluation of 120 patients at defined risk for colorectal neoplasia was performed with CT colonography followed by colonoscopy on the same day. Subjects were stratified by age and sex (67 women and 53 men) and were randomized to receive either manual air (n = 61) or CO₂ (n = 59) insufflation during CT colonography. Patients' expectations were assessed just before the two examinations, and appraisals were assessed 2 to 3 days afterward regarding pain/discomfort, embarrassment, difficulty, overall assessment, preference for future testing, and bowel preparation. RESULTS: No significant differences were found in appraisals of manual air versus CO₂ insufflation techniques. For both CT colonography and colonoscopy, patients' appraisals after the procedure were significantly more positive than prior expectations. Patients expressed more favorable appraisals of colonoscopy for pain (p < 0.001) and embarrassment (p < 0.001), with most responses being "none" to "a little" for both examinations. Overall appraisals of the tests were favorable and similar between CT and colonoscopy: patients mainly expressed "not unpleasant" to "a little unpleasant" (95%, 114/120 for both examinations). Overall, appraisal of the bowel preparation was the most negative. Preferences for future testing were more favorable toward CT: of the patients, 58% (69/120) preferred CT, 14% (17/120) preferred colonoscopy, and 28% (34/120) had no preference. CONCLUSIONS: Overall appraisals were similar and positive for both CT colonography and colonoscopy, with less favorable appraisals of the bowel preparation. Most patients stated that they would prefer CT for future evaluation.