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Development and validation of a nurse-assessed patient comfort score for colonoscopy

Lookup NU author(s): Dr Matthew Rutter, Dr Tom Lee, Professor Colin Rees


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Background: Comfort during colonoscopy is a critical component of safety and quality. Objective: To develop and validate the Nurse-Assessed Patient Comfort Score (NAPCOMS). Design: Prospective scale validation. Setting: Colorectal cancer screening centers in the United Kingdom and Canada. Patients: A total of 300 consecutive patients undergoing colonoscopy at participating colorectal cancer screening centers. Intervention: The NAPCOMS was developed by using a modified Delphi process. During colonosco`py, two endoscopy room nurses independently observed and rated patient comfort and tolerability by using NAPCOMS. In addition, endoscopists reported global comfort scores and patients' reported global comfort by using visual 4-point Likert and National Health Service-United Kingdom Global Rating Scales. Main Outcome Measurements: Reliability and validity of NAPCOMS was measured by using intraclass correlations (ICC) between nurse ratings of colonoscopies and between NAPCOMS, endoscopist ratings, and patient ratings of global comfort. Results: The ICC for the overall NAPCOMS was 0.84 (95% confidence interval [CI], 0.80-0.87). There was high agreement between the NAPCOMS and endoscopist ratings of comfort (ICC = 0.77; 95% CI, 0.72-0.81), moderate agreement between the NAPCOMS and patient ratings (ICC = 0.61; 95% CI, 0.53-0.67), and moderate agreement between the endoscopist and patient ratings (ICC = 0.52; 95% CI, 0.43-0.60). Limitations: NAPCOMS was validated in outpatients who received colonoscopy with minimal to moderate sedation as part of a screening and surveillance program, so performance among inpatients or those requiring deep sedation was not tested. Conclusion: NAPCOMS is a reliable and valid tool for assessing patient comfort in the setting of outpatient colonoscopy performed with minimal to moderate sedation. (Gastrointest Endosc 2013; 77: 255-61.)

Publication metadata

Author(s): Rostom A, Ross ED, Dube C, Rutter MD, Lee T, Valori R, Bridges RJ, Pontifex D, Webbink V, Rees C, Brown C, Whetter DH, Kelsey SG, Hilsden RJ

Publication type: Article

Publication status: Published

Journal: Gastrointestinal Endoscopy

Year: 2013

Volume: 77

Issue: 2

Pages: 255-261

Print publication date: 01/02/2013

ISSN (print): 0016-5107

ISSN (electronic): 1097-6779

Publisher: Mosby, Inc.


DOI: 10.1016/j.gie.2012.10.003


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