Patient Acceptability and Psychologic Consequences of CT Colonography Compared with Those of Colonoscopy: Results from a Multicenter Randomized Controlled Trial of Symptomatic Patients

Published Online:https://doi.org/10.1148/radiol.12111523

Findings from this randomized controlled trial suggest the immediate experience of CT colonography is more acceptable to patients than colonoscopy, but postprocedural differences in the way results are delivered favor colonoscopy.

Purpose

To use a randomized design to compare patients’ short- and longer-term experiences after computed tomographic (CT) colonography or colonoscopy.

Materials and Methods

After ethical approval, the trial was registered. Patients gave written informed consent. Five hundred forty-seven patients with symptoms suggestive of colorectal cancer who had been randomly assigned at a ratio of 2:1 to undergo either colonoscopy (n = 362) or CT colonography (n = 185) received a validated questionnaire to assess immediate test experience (including satisfaction, worry, discomfort, adverse effects) and a 3-month questionnaire to assess psychologic outcomes (including satisfaction with result dissemination and reassurance). Data were analyzed by using Mann-Whitney U, Kruskal-Wallis, and χ2 test statistics.

Results

Patients undergoing colonoscopy were less satisfied than those undergoing CT colonography (median score of 61 and interquartile range [IQR] of 55–67 vs median score of 64 and IQR of 58–70, respectively; P = .008) and significantly more worried (median score of 16 [IQR, 12–21] vs 15 [IQR, 9–19], P = .007); they also experienced more physical discomfort (median score of 39 [IQR, 29–51] vs 35 [IQR, 24–44]) and more adverse events (82 of 246 vs 28 of 122 reported feeling faint or dizzy, P = .039). However, at 3 months, they were more satisfied with how results were received (median score of 4 [IQR, 3–4] vs 3 [IQR, 3–3], P < .0005) and less likely to require follow-up colonic investigations (17 of 230 vs 37 of 107, P < .0005). No differences were observed between the tests regarding 3-month psychologic consequences of the diagnostic episode, except for a trend toward a difference (P = .050) in negative affect (unpleasant emotions such as distress), with patients undergoing CT colonography reporting less intense negative affect.

Conclusion

CT colonography has superior patient acceptability compared with colonoscopy in the short term, but colonoscopy offers some benefits to patients that become apparent after longer-term follow-up. The respective advantages of each test should be balanced when referring symptomatic patients.

© RSNA, 2012

Clinical trial registration no. ISRCT95152621

Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12111523/-/DC1

References

  • 1 Thompson MR, Perera R, Senapati A, Dodds S. Predictive value of common symptom combinations in diagnosing colorectal cancer. Br J Surg 2007;94(10):1260–1265. Crossref, MedlineGoogle Scholar
  • 2 Warren JL, Klabunde CN, Mariotto AB, et al.. Adverse events after outpatient colonoscopy in the Medicare population. Ann Intern Med 2009;150(12):849–857. Crossref, MedlineGoogle Scholar
  • 3 Thomeer M, Bielen D, Vanbeckevoort D, et al.. Patient acceptance for CT colonography: what is the real issue? Eur Radiol 2002;12(6):1410–1415. Crossref, MedlineGoogle Scholar
  • 4 van Gelder RE, Birnie E, Florie J, et al.. CT colonography and colonoscopy: assessment of patient preference in a 5-week follow-up study. Radiology 2004;233(2):328–337. LinkGoogle Scholar
  • 5 Rockey DC. Computed tomographic colonography: current perspectives and future directions. Gastroenterology 2009; 137(1):7–14. Crossref, MedlineGoogle Scholar
  • 6 Pickhardt PJ, Hassan C, Halligan S, Marmo R. Colorectal cancer: CT colonography and colonoscopy for detection—systematic review and meta-analysis. Radiology 2011;259(2):393–405. LinkGoogle Scholar
  • 7 Marshall DA, Johnson FR, Kulin NA, et al.. How do physician assessments of patient preferences for colorectal cancer screening tests differ from actual preferences? a comparison in Canada and the United States using a stated-choice survey. Health Econ 2009;18(12):1420–1439. Crossref, MedlineGoogle Scholar
  • 8 von Wagner C, Knight K, Halligan S, et al.. Patient experiences of colonoscopy, barium enema and CT colonography: a qualitative study. Br J Radiol 2009;82(973):13–19. Crossref, MedlineGoogle Scholar
  • 9 Halligan S, Lilford RJ, Wardle J, et al.. Design of a multicentre randomized trial to evaluate CT colonography versus colonoscopy or barium enema for diagnosis of colonic cancer in older symptomatic patients: the SIGGAR study. Trials 2007;8:32. Crossref, MedlineGoogle Scholar
  • 10 Medical Research Council. MRC guidelines for good clinical practice. http://www.mrc.ac.uk/Utilities/Documentrecord/index.htm?d=MRC002416. Published 1998. Google Scholar
  • 11 von Wagner C, Smith S, Halligan S, et al.. Patient acceptability of CT colonography compared with double contrast barium enema: results from a multicentre randomised controlled trial of symptomatic patients. Eur Radiol 2011;21(10):2046–2055. Crossref, MedlineGoogle Scholar
  • 12 Noble M, McLennan D, Wilkinson K, Barnes H. The English indices of deprivation 2007. London, England: Communities and Local Government, 2007. Google Scholar
  • 13 Salmon P, Shah R, Berg S, Williams C. Evaluating customer satisfaction with colonoscopy. Endoscopy 1994;26(4):342–346. Crossref, MedlineGoogle Scholar
  • 14 Cockburn J, De Luise T, Hurley S, Clover K. Development and validation of the PCQ: a questionnaire to measure the psychological consequences of screening mammography. Soc Sci Med 1992;34(10):1129–1134. Crossref, MedlineGoogle Scholar
  • 15 Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol 1988;54(6):1063–1070. Crossref, MedlineGoogle Scholar
  • 16 Tabachnick BG, Fidell LS. Using multivariate statistics. 5th ed. Boston, Mass: Allyn & Bacon, 2007. Google Scholar
  • 17 Gluecker TM, Johnson CD, Harmsen WS, et al.. Colorectal cancer screening with CT colonography, colonoscopy, and double-contrast barium enema examination: prospective assessment of patient perceptions and preferences. Radiology 2003;227(2):378–384. LinkGoogle Scholar
  • 18 Taylor SA, Halligan S, Saunders BP, Bassett P, Vance M, Bartram CI. Acceptance by patients of multidetector CT colonography compared with barium enema examinations, flexible sigmoidoscopy, and colonoscopy. AJR Am J Roentgenol 2003;181(4):913–921. Crossref, MedlineGoogle Scholar
  • 19 von Wagner C, Halligan S, Atkin WS, Lilford RJ, Morton D, Wardle J. Choosing between CT colonography and colonoscopy in the diagnostic context: a qualitative study of influences on patient preferences. Health Expect 2009;12(1):18–26. Crossref, MedlineGoogle Scholar
  • 20 Marshall DA, Johnson FR, Phillips KA, Marshall JK, Thabane L, Kulin NA. Measuring patient preferences for colorectal cancer screening using a choice-format survey. Value Health 2007;10(5):415–430. Crossref, MedlineGoogle Scholar
  • 21 Nayaradou M, Berchi C, Dejardin O, Launoy G. Eliciting population preferences for mass colorectal cancer screening organization. Med Decis Making 2010;30(2):224–233. Crossref, MedlineGoogle Scholar
  • 22 Hawley ST, Volk RJ, Krishnamurthy P, Jibaja-Weiss M, Vernon SW, Kneuper S. Preferences for colorectal cancer screening among racially/ethnically diverse primary care patients. Med Care 2008;46(9 suppl. 1):S10–S16. Crossref, MedlineGoogle Scholar
  • 23 Johnson CD, Chen MH, Toledano AY, et al.. Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med 2008;359(12):1207–1217. Crossref, MedlineGoogle Scholar

Article History

Received July 20, 2011; revision requested August 29; revision received October 18; accepted November 19; final version accepted December 29.
Published online: June 2012
Published in print: June 2012