Abstract
BackgroundUpper gastrointestinal endoscopy is the most preferable diagnostic examination for patients over fifty when upper gastrointestinal symptoms appear. However, limited knowledge exists in concerns to the compliance of primary care patients' to the doctors' recommendations for endoscopy.MethodsPatients who visited primary care practices in Greece and experienced upper gastrointestinal symptoms within a 10 days screening study, were referred for an upper endoscopy exam. The patients which refused to complete the endoscopy exam, were interviewed by the use of an open- ended translated and validated questionnaire, the Identification of Dyspepsia in General Population (IDGP) questionnaire. A qualitative thematic analysis grounded on the theory of planned behavior was performed to reveal the reasons for patients' refusal, while socio-demographic predictors were also assessed.ResultsNine hundred and ninety two patients were recorded, 159 of them (16%) were found positive for dyspepsia and gastro-esophageal reflux disease according to the IDGP questionnaire. Out of the above, 131 (83.6%) patients refused further investigation with endoscopy. Patients who refused upper endoscopy were predominantly female (87.8%) (p = 0.036) and over the age of 50. The lack of severe symptoms, fear of pain, concerns of sedation, comorbidity and competing life demands were reported by patients as barriers to performing an endoscopic investigation.ConclusionsPatients with dyspepsia in rural Greece tend to avoid upper gastrointestinal endoscopy, with two major axons considered to be the causes of patients' refusal: their beliefs towards endoscopy and their personal capability to cope with it. Future research examining reasons of low compliance should be carried out in combination with modern behavioral theories so as to investigate into the above.
Highlights
Upper gastrointestinal endoscopy is the most preferable diagnostic examination for patients over fifty when upper gastrointestinal symptoms appear
This paper reports the findings of a qualitative study that was designed to reveal patients’ reasons for refusing to undergo an endoscopy recommendation by their personal physicians within the use of the Theory of Planned Behaviour (TPB)
Participants’ characteristics According to the IDGP questionnaire, 159 patients were found positive with upper gastrointestinal symptoms, while 131 (83.6%) of them refused to proceed to an EGD
Summary
Upper gastrointestinal endoscopy is the most preferable diagnostic examination for patients over fifty when upper gastrointestinal symptoms appear. Limited knowledge exists in concerns to the compliance of primary care patients’ to the doctors’ recommendations for endoscopy. It has been shown that their impact on general practices may be eminently critical in order to invalidate the. Factors such as family history, perceived risk, self-efficacy, knowledge of the disease, or the use of educational videotaped material, were not proved to influence patients’ decision about colorectal cancer (CRC) screening with a Faecal Occult Blood Test (FOBT) [8]. Explaining and modifying patients’ attitudes in order to obtain higher compliance rates requires a thorough knowledge of the factors that may influence their decision making process. Emphasis is given currently on patient centered communication and shared decision making that seem to lead to a significant increase in patient knowledge, improve quality of life and patient’s satisfaction towards medical care, and to reduce the anxiety and decisional conflict [10,11]
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