Table 1 An overview of the constructs regarding definitions, domains, and indicators
Constructs | Time periods | Definitions | Domains | Indicators |
|---|---|---|---|---|
Health motivation | Overall | Absence of disease and an interest in gaining knowledge about their bowel health motivate the patients to endure the procedure despite fear of a potential diagnosis. Knowledge seems to support the decision to proceed and reduce anxiety as well as increasing confidence in the colonoscopy | To determine bowel health | 1. Wish to find out 2. Has to be undergone 3. To stay in line 4. To make sure everything is OK |
Thoughts about potential diagnosis | 5. Worries about having cancer 6. Wanted to find out in time for treatment | |||
Knowledge | 7. Knowledge about colorectal cancer 8. Knowledge about colonoscopy and the possibility of detection of anomalies 9. Go through the procedure regularly due to colorectal cancer screening | |||
Discomfort | Before | A time when the patients may experience burdensome specified preparations to empty the colon. Patients with pre-existing conditions are likely to worry that the specified preparations may exacerbate their medical conditions. The time prior to colonoscopy is also characterised by logistical planning regarding transportation and time away from other duties | Impact on chronic diseases | 1. For individuals with diabetes, worries to do with having to stay away from food, blood sugar levels and unclarity regarding insulin 2. Medical chronical conditions that impede the ability to drink large volumes |
Dietary guidelines | 3. Lack of information 4. Tiresome to follow dietary guidelines and the required food preparation | |||
Bowel preparation | 5. Uncertainty about instructions 6. Burdensome and inconvenient to drink large amounts of fluid with bad taste 7. Tolerated the bowel preparation due to motivation 8. Challenging to finish the bowel preparation 9. Nausea and/or vomiting 10. Feeling cold 11. Impact on sleep due to toilet visits 12. Painful to go to the toilet due to sore bottom | |||
Logistics | 13. Transportation seen as a burden 14. Support with transportation home due to intake of sedation | |||
During | A time when the situation may be experienced as exposed and embarrassing. Experiences of different degrees of discomfort and/or pain may occur but can be eased with sedation and/or support from staff | Exposed situation | 15. Embarrassment and an awkward situation 16. Overwhelming experience and disturbed safety | |
Discomfort/pain | 17. Unpleasant sensory experience 18. Different degrees of pain and peaks of pain | |||
Sedation | 19. Sedated vs. awake according to wishes and personal preferences 20. Good effect of sedation in managing discomfort | |||
Support | 21. Guidance from healthcare professionals’, e.g., regarding relaxation and breathing 22. Aided by physical contact 23. Aided by change in position 24. Aided by pausing the intubation of colon 25. Difficulties to verbally express discomfort 26. Difficulties to verbally express pain | |||
After | A time when the patients may experience physical exhaustion and a need to recover, as well as changed bowel habits and bloating | Exhausted | 27. Physical tiredness due to lack of sleep or sedative/pain medication | |
Impact on bowel habits | 28. Changed bowel habits 29. Bloated | |||
Information | Before | Facts and understanding regarding preparations and the process of undergoing a colonoscopy | Preparedness | 1. Lack of information regarding diet and/or bowel preparation 2. Lack of information regarding the colonoscopy 3. Clear vs. confusing information |
Information seeking Verbal confirmation | 4. Gathering of additional information 5. Source criticism | |||
Topic of conversation | 6. Inappropriate to talk about and discuss a colonoscopy procedure with others | |||
During | Sharing of information regarding the procedure between healthcare professionals and the patient as well as understanding of the given information | Sharing of information | 7. Fascinating vs. disgusting to watch the monitor 8. Explaining the procedure | |
Understanding information | 9. Problems remembering given information 10. Lack of full comprehension due to sedation 11. Persistent effect of sedation 12. Unanswered questions due to lack of knowledge or dizziness when discharged | |||
After | Either a preliminary or a definitive colonoscopy result given by the healthcare professionals to the patient after the procedure | The result | 13. Lacked feedback concerning bowel preparation 14. Frustration due to lack of information 15. Reassuring to get the result 16. Result after procedure/recovery 17. Relief to get the result 18. Grateful to get the result | |
A caring relationship | During | A colonoscopy-specific caring relationship is based on the healthcare professionals’ positive attitude and courtesy towards the patient. In addition to this, it is essential that patients have confidence in the competence of the healthcare professional. Respectful interactions are a prerequisite for the creation of a caring relationships | Behaviour | 1. Reassurance 2. Calm and comfort 3. Humour/Verbal praise 4. Nice manners/Well treated 5. Positive and friendly atmosphere 6. Feeling of being respected, safe and cared for 7. Treated as an individual |
Competence | 8. Trust in the healthcare professionals’ knowledge | |||
Relationship-building interactions | 9. Healthcare professionals’ responsive to individual needs, easing anxiety 10. Treated as a partner 11. In control due to the possibility to stop the examination if needed | |||
Understanding | Before | For some patients, a time characterised by fear of potential complications. Patients without former experience of undergoing a colonoscopy are unsure of what will happen during the procedure and sometimes brood about the upcoming event. Negative previous experiences increase anxiety and serve as a barrier to undergoing the procedure, while positive previous experiences often reduce uncertainty and worries | Worries | 1. Fear of complications 2. Concerns about safety and exaggerated negative expectations beforehand 3. Not knowing what to expect regarding sedation, pain, bowel movement |
Former experiences | 4. Knowledge and understanding of the procedure 5. Previous experience prepared for the future | |||
After | A time characterised by a re-evaluation of the patients’ expectations prior to the colonoscopy and of their actual experience of undergoing the procedure. The patients’ willingness to repeat the procedure is affected by their assessment of the experiences | Willingness to repeat | 6. Expectations not matching reality 7. View of the procedure changed afterwards 8. To experience a colonoscopy was demystifying |