In recent years, the systematic evaluation of quality indicators has represented a significant change in clinical practice for most endoscopists.1 Many studies have evaluated different key colonoscopy performance measures; however, they aimed to analyze the performance of the procedure, rather than improving the patient experience.1, 2, 3, 4, 5, 6, 7, 8, 9, 10 On the other hand, several non-procedural factors have been found to influence the patient's experience, like the colonoscopy unit environment, the lack of information provided before and after the procedure, and the technical skill of the endoscopist that performed the examination. Moreover, some factors have emerged as most important to patients, like the discomfort experienced during the bowel preparation period, pain during the procedure, or long waiting times8, 9, 10, 11). Nevertheless, the majority of studies have been conducted without significant patient input or feedback.12, 13

There is a need for colonoscopy services to implement improvements based on patient opinions, in addition to suggestions from health professionals.14, 15 Therefore, to improve the quality of colonoscopy procedures, patient experiences should be measured with questionnaires designed specifically for this purpose.

To address the need for instruments designed to collect patient experiences and opinions, our group recently developed and validated the Colonoscopy Satisfaction and Safety Questionnaire based on patient experience (CSSQP).8 This tool covered the entire patient experience, from scheduling the procedure to discharge from the endoscopy unit. The CSSQP was designed to record the experience of patients undergoing a colonoscopy and was tested on a focus group selected from the Spanish Colorectal Cancer (CRC) Screening program. With this questionnaire, new indicators of quality and safety based on patient-reported outcomes (PROMs) were identified. Two recent systematic reviews have shown that, until now, only two existing PROMs designed to measure patient satisfaction have been validated. The authors identified the CSSQP with high potential for further use.16, 17 Furthermore, a novel meta-analysis of randomized controlled trials recommends their use as validated measures of patient satisfaction to improve comparisons between studies and meta-analyses.18 Innovate aspects of the CSSQP, compared to other questionnaires, were that it was based on the patient's perspective, it used qualitative methodology, and it included the safety from patient's perspective. However, the validation study was carried out in only two centers within the CRC screening program. In addition, patients who did not respond to the questionnaire were not included in the analysis.

The primary aim of this study was to identify factors related to patient experience (satisfaction and safety perceived by the patient) using the CSSQP, including all indications for colonoscopy. The secondary objectives were to investigate whether the CSSQP is a valid tool to compare satisfaction and safety indicators between centers; and to analyze the characteristics of non-responders to the questionnaire.