Clinician-reported Gloucester Comfort Scale scores underestimate patient discomfort and pain during colonoscopy: insights from comparison with a patient-reported experience measure.

Background: Patient experience is a fundamental element of colonoscopy. The Gloucester Comfort Scale (GCS) is used by clinicians to report patient comfort. However, insights regarding the extent to which clinician-reported GCS scores represent the patient's experience are lacking. We assessed the level of agreement between clinician-reported GCS scores and patient-reported discomfort and pain.

Methods: Consecutive patients undergoing colonoscopy at two Dutch endoscopy clinics were included. Patient comfort during colonoscopy was reported using the GCS (1-5 scale). Patients' colonoscopy experience was assessed using the Newcastle ENDOPREM, a validated endoscopy patient-reported experience measure (PREM). Patients reported both discomfort and pain levels experienced during colonoscopy on a 1-5 scale. Levels of agreement were assessed using Cohen's kappa statistic.

Results: For 243 included patients, the GCS score was higher than the discomfort score in 52 (21%) patients, and lower in 72 (30%). GCS score was higher than the pain score in 39 (16%) patients, and lower in 71 (29%). Moderate to severe discomfort and pain (scores 3) were reported by 53 (22%) patients for discomfort and 60 (25%) patients for pain. For these patients, the GCS underestimated discomfort and pain levels in almost all cases (discomfort: 49/53 [92%], pain: 54/60 [90%]). The levels of agreement between GCS scores and discomfort and pain scores were minimal (Cohen's κ: 0.34) and weak (Cohen's κ: 0.47), respectively.

Conclusions: Clinician-reported GCS scores frequently underestimate the level of discomfort and pain as reported by patients. For accurate monitoring of patients' colonoscopy experience, the use of PREMs should be considered.