Interobserver variability in comfort scores for screening colonoscopy

Objective To investigate the agreement in comfort scores between patients, endoscopist and specialist screening practitioner (SSP) for colonoscopy, and which factors influence comfort. Design Prospective observational study. Setting Single-centre UK Bowel Cancer Screening Program colonoscopy service from April 2017 to March 2018. Patients 498 patients undergoing bowel cancer screening colonoscopy, with median age of 68 (IQR 64-71). 320 (64.3%) were men. Intervention All patients underwent screening colonoscopy. Main outcome measure Comfort scores on a validated 1 (best) to 5 (worst) ordinal scale were assigned for each colonoscopy by the patient, endoscopist and SSP. Inter-rater agreement of discomfort scores between endoscopist, patient and SSP was investigated using Cohen's Kappa statistic. Multivariate ordinal logistic regression was used to investigate the effects of patient and colonoscopy factors on comfort scores. Results SSPs had superior comfort score agreement with patients (0.638; 'moderate agreement') than endoscopists had with the same patients (0.526; 'weak agreement'). Male patients reported lower scores than female patients (OR 0.483, OR 0.499 [95% CI 0.344 to 0.723]; p<0.001). Endoscopists reported lower scores when there was better bowel prep (OR 0.512 [95% CI 0.279 to 0.938]; p=0.030). Agreement was worse at higher levels of discomfort. Conclusion There is variability in perceived comfort levels between healthcare providers and patients during screening colonoscopy, which is greater at worse levels of discomfort. Endoscopists who undertake screening colonoscopies may wish to consider both patient and healthcare provider comfort scores in order to improve patient experience while ensuring optimal quality assurance.