Systematic Review: Anxiety Related to Colonoscopy and Flexible Sigmoidoscopy
Bibliographic record
Abstract
Introduction: Colorectal cancer (CRC) is the second most common cause of cancer related deaths in North America. Colonoscopy and flexible sigmoidoscopy are common procedures used to screen for CRC. One of the biggest barriers to undergo screening for CRC is the anxiety associated with these procedures. A better understanding of the anxiety that patients may have will help improve adherence to CRC screening. This systematic review identifies the magnitude of anxiety, types of concerns, and predictors of anxiety in patients undergoing colonoscopy or flexible sigmoidoscopy, as well as interventions aimed to reduce this anxiety. Methods: Medline, Embase, CINAHL, PsychInfo, Web of Science, Scopus and Cochrane Library were searched for randomized controlled trials (RCTs), observational studies and case series from the past 10 years to present. Two team members independently screened the studies for eligibility for inclusion. Relevant data were extracted. The studies were assessed for methodological quality. The primary outcomes were magnitude of anxiety, types of concerns related to anxiety, predictors of anxiety, and degree of anxiety reduction by various interventions. Results: 53 studies were included in this systematic review, including 14 RCTs, 38 observational trials and 1 case series. The magnitude of anxiety based on State-Trait Anxiety Inventory (STAI) score varied from 33 to 50 (out of 80) between studies for colonoscopy, and 40 to 46 for flexible sigmoidoscopy. Types of concerns for colonoscopy may be bowel preparation-related (embarrassment: 36%, pain: 39%, burdensome: 34%), procedure-related (pain: 28-57%, complications: 21-53%, sedation: 18-30%, embarrassment: 16-44%), or diagnosis-related (fear of cancer: 31-52%). Several predictors are associated with colonoscopy-related anxiety, including female gender, higher baseline anxiety, and lower socioeconomic status. Providing additional information in the form of video or written material prior to colonoscopy appear to be effective in lowering anxiety. Conclusion: Majority of patients undergoing colonoscopy or flexible sigmoidoscopy appear to have clinically significant anxiety. In comparison, STAI scores range from 37.6 to 44.4 for preoperative surgical patients, and around 33.1 for general adult population. A variety of concerns have been reported. Certain patient characteristics may help physicians identify those more prone to have pre-procedural anxiety and would benefit from additional information to help lower their anxiety.Table: Table. Types of concerns related to colonoscopyTable: Table. Predictors of anxiety in patients considering or undergoing colonoscopy
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.044 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.009 |
| Bibliometrics | 0.006 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".