Bowel preparation experiences and needs before follow-up colonoscopy in older adult postoperative colorectal cancer patients: A qualitative study

Abstract

BACKGROUND

The bowel preparation process prior to colonoscopy determines the quality of the bowel preparation, which in turn affects the quality of the colonoscopy. Colonoscopy is an essential procedure for postoperative follow-up monitoring of colorectal cancer (CRC) patients. Previous studies have shown that advanced age and a history of colorectal resection are both risk factors for inadequate bowel preparation. However, little attention has been paid to the bowel preparation experiences and needs of predominantly older adult postoperative CRC patients.

AIM

To explore the experiences and needs of older adult postoperative CRC patients during bowel preparation for follow-up colonoscopy.

METHODS

Fifteen older adult postoperative CRC patients who underwent follow-up colonoscopy at a tertiary hospital in Shanghai were selected using purposive sampling from August 2023 to November 2023. The phenomenological method in qualitative research was employed to construct an interview outline and conduct semi-structured interviews with the patients. Colaizzi's seven-step analysis was utilized to organize, code, categorize, summarize, and verify the interview data.

RESULTS

The results of this study were summarized into four themes and eight sub-themes: (1) Inadequate knowledge about bowel preparation; (2) Decreased physiological comfort during bowel preparation (gastrointestinal discomfort and sleep deprivation caused by bowel cleansing agents, and hunger caused by dietary restrictions; (3) Psychological changes during different stages of bowel preparation (pre-preparation: Fear and resistance due to previous experiences; during preparation: Irritation and helplessness caused by taking bowel cleansing agents, and post-preparation: Anxiety and worry while waiting for the colonoscopy); and (4) Needs related to bowel preparation (detailed instructions from healthcare professionals; more ideal bowel cleansing agents; and shortened waiting times for colonoscopy).

CONCLUSION

Older adult postoperative CRC patients' knowledge of bowel preparation is not adequate, and they may encounter numerous difficulties and challenges during the process. Healthcare professionals should place great emphasis on providing instruction for their bowel preparation.

Keywords: Older people; Colorectal cancer; Colonoscopy; Bowel preparation; Health promotion; Nursing; Qualitative research

Core Tip: Patient experiences during bowel preparation significantly influence compliance and the quality of colonoscopies. Older adult postoperative colorectal cancer patients are particularly prone to poor bowel preparation quality. This study, using a phenomenological methodology with semi-structured interviews, explored the bowel preparation experiences and needs of these patients. Unexpectedly, it revealed that despite prior experience, their knowledge of bowel preparation was still inadequate. They faced substantial physical and psychological challenges, with specific needs identified during the process. This research can inform customized bowel preparation plans for this high-risk group and suggests future studies on the impact of psychological factors on bowel preparation quality.