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We read with interest the British Society of Gastroenterology (BSG) lead audit by Bowles et al (Gut53:277–83) into colonoscopy practice within the UK. As part of the audit the authors questioned 1200 patients on their experience of the procedure. Of the respondents, only 81.5% received written information, with only 54.9% recalling information on possible adverse events such as bleeding and perforation. The poor recollection of potential problems is perhaps to be expected if the audit questionnaire was sent to patients sometime after the procedure.
In common with many endoscopy units, we send out an information leaflet with the patient’s appointment details. This explains the preparation required, what to expect on the day, and any potential complications, with advice as to what to do should these complications arise. As there are concerns regarding patients’ understanding of potential complications related to endoscopy, we designed a short questionnaire to determine how much information patients were able to recall from the information leaflet sent to them prior to colonoscopy. This consisted of four multichoice questions with five possible answers, of which only one was correct. The correct answers were all in the information leaflet. Patients were requested to complete the questionnaire just prior to discharge, at least one hour after procedure completion, thus minimising the effects of sedation. The questions related to: the risk of perforation; the degree of rectal bleeding that required medical assistance; what to do should a problem arise out of office hours; and the correct means of getting home after receiving sedation.
Thirty three patients completed the colonoscopy questionnaire and of these only 37% answered all four questions correctly. Only 52% of patients remembered correctly the perforation rate from diagnostic colonoscopy, which was stated as 1 in a 1000 in our information leaflet. Worryingly, 12 patients (36%) thought that perforation rates were 10–100-fold lower than stated in the information leaflet.
Our study demonstrates that patients fail to fully appreciate the risks of colonoscopy despite the distribution of detailed written information prior to the procedure. This could have medicolegal implications should complications arise and reinforces the need for improved methods of informing patients.