Elsevier

Gastrointestinal Endoscopy

Volume 49, Issue 2, February 1999, Pages 158-162
Gastrointestinal Endoscopy

Effectiveness and patient satisfaction with screening flexible sigmoidoscopy performed by registered nurses☆,☆☆,★

https://doi.org/10.1016/S0016-5107(99)70480-3Get rights and content

Abstract

Background: Our aim was to compare the effectiveness and patient satisfaction with flexible sigmoidoscopy performed by a registered nurse, general surgeons, and gastroenterology fellows. Methods: Consecutive outpatients referred for sigmoidoscopy were assigned to have the procedure performed by the first available provider. Depth of insertion of the sigmoidoscope, complications, duration of the procedure, and percentage of patients with adenomas were recorded. After the procedure, patients completed a validated patient satisfaction questionnaire. Results: Mean depth of insertion was less for general surgeons compared with the nurse and gastroenterology fellows (50 vs 53 vs 54 cm, respectively; p = 0.01). Mean duration of procedure was longer for the nurse compared with general surgeons and gastroenterology fellows (8.3 vs 7.6 vs 6.8 min, respectively; p = 0.0001). Percentage of patients with adenomas was similar among patients who underwent sigmoidoscopy by the endoscopists (7% vs 8% vs 9%; p = 0.81). No differences were detected between endoscopists for overall satisfaction (p = 0.60), technical skills of the endoscopist (p = 0.58), communication skills of the endoscopist (p = 0.61), or interpersonal skills of the endoscopist (p = 0.59). Conclusion: No clinically significant differences in effectiveness or patient satisfaction were detected with flexible sigmoidoscopy performed by a registered nurse, general surgeons, or gastroenterology fellows. (Gastrointest Endosc 1999;49:158-62.)

Section snippets

PATIENTS AND METHODS

Six months before this study, a certified gastroenterology RN began a training program in the performance of FS. Didactic training included assigned reading on the anatomy of the colon and the performance of FS.17, 18 The next stage of training included (1) practice with the sigmoidoscope on a plastic model; (2) 5 withdrawals of the sigmoidoscope on patients after insertion of the sigmoidoscope by a physician; (3) 20 insertions and withdrawals of the sigmoidoscope in the presence of a

RESULTS

Four hundred seventeen eligible patients were referred for FS during the study period. Ten patients refused to participate and 24 patients did not complete the questionnaire after the FS and were excluded from analysis. Of the 383 patients who completed the study, mean age was lower for the patients who underwent sigmoidoscopy by the gastroenterology fellows (55.8 ± 13.7 years) than for the general surgeons (60.5 ± 12.5 years) or the RN (61.4 ± 12.0 years) (p = 0.001). No statistically

DISCUSSION

Over 50 million Americans will be eligible for screening FS by the year 2000.6 If these patients follow the recommended guidelines (FS once every 5 years), as many as 10 million FS per year could be performed. Although only a small percentage of the U.S. population has been screened with FS,5 the provision of Medicare reimbursement is expected to significantly increase the use of colorectal cancer screening services. Given the predicted increase in performance of FS, trained paramedical

Acknowledgements

The authors are indebted to Derek King, BSc Mathematics, for statistical support in the preparation of this manuscript.

The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Navy, the Department of Defense, or the U.S. Government.

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    ☆

    Sponsored by The Chief, Navy Bureau of Medicine and Surgery, Washington, DC, Clinical Investgation Program (B97-005).

    ☆☆

    Reprint requests: Philip S. Schoenfeld, MD, MSEd, Division of Gastroenterology, National Naval Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889-5000.

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    Copyright © 1999 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.