Communication & satisfaction whilst undergoing barium enema examination

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Communication & satisfaction whilst undergoing barium enema examination

Health communication covers a wide range of topics, but a central focus is health care provider-patient communication, specifically, issues involving patient satisfaction and compliance. Patient compliance is defined as “the extent to which patients follow clinical prescriptions” (Burgoon, Bark, & Hall, 1991) Patient satisfaction is less easily defined, as it is highly dependent upon what the patient considers satisfying. Trying to understand the behaviours that lead to both patient compliance and patients satisfaction can help to gain positive outcomes for both patient and the health care provider.

There is evidence to indicate that patients view communication as an issue that is central to their care. (Reading, A.E. 1981 & Reading, A.E. 1982) It seems to have an influence on patient’s behaviour and well-being, for example satisfaction with care, compliance to treatment, recall and understanding, quality of life, and even state of health (Smith C.K. et al 1981).

Poor communication can lead to non-compliance. The costs associated with non-compliance can be high not only to the patient, but also to the health care system. As suggested by Ley (1988) and Farberow (1986), “In economic terms, the expense of non-compliance is staggering … in human terms, the expense is tragic.” To avoid it happening communication should be seen as a key to a successful patient care.

While much is known about communication and satisfaction the actual experience of communication and satisfaction during barium enema examination has not been thoroughly documented. There is therefore little information to guide radiographers on how to communicate and satisfy patients undergoing barium enema. The following essay discusses how the radiographer or radiologist (a doctor specialising in the use and the interpretation of x-rays ()) can enhance patient compliance and satisfaction by providing communication whilst carrying out barium enema procedure.

A barium enema, or lower gastrointestinal (GI) examination, is an X-ray examination of the large intestine, which consists of cecum, colon, rectum and anal canal ()

(See appendix 1 for an image). To make the large intestine visible on an X-ray picture, the colon is filled with a contrast material containing barium. There are two types of this test: the single contrast technique where barium enema sulphate is injected into the rectum to outline the intestine and reveal large abnormalities; and the double-contrast (or “air contrast”) technique where air is inserted into the rectum to provide a detailed view of inner surfaces of large intestine (). In order to conduct the most accurate barium enema test, the patient must follow a low-residue diet and bowel preparation prior to examination to clean the large intestine (). This preparation commonly includes restricted intake of diary products, liquid and a diet for 24 hours prior to the test, in addition to drinking plenty of clear fluids including water, fizzy drinks, clear soup/meat extract drinks ().

Also on the day before the test the patient is asked to take a combination of laxatives (such as PICOLAX, castor oil, magnesium citrate) to help to empty the large intestine ().

The test may be performed for a variety of reasons and is used to help diagnose diseases that affect the large intestine, e.g. colorectal cancer, polyps, diverticula, inflammatory disease etc. (). The success of the examination depends on the large intestine being completely clear of faecal material and gas. Even a small amount of faecal material can affect the result (). Many people report that the preparation and bowel cleaning are the most difficult parts of the test () therefore clear communication is necessary before, during and after the barium enema examination.

Barium enema examination involves some risk of radiation exposure. The radiation exposure is minimised by standard techniques, which have been assigned and approved by national and international radiology protection councils (). The effective radiation dose from the barium enema procedure is about 4 mSv, which is about the same as the average person receives from background radiation in 16 month () and is generally very low compared with the benefits ().

It’s very important to prepare the patient both physically and mentally by providing clear information about what is going to happen to him/her. The patient has the right to be given clear information about any aspect of the treatment or care received (DoH, 1992) and his/her needs have to be met: “the need to know and understand” and “the need to feel known and understood” (Ong et al. 1995).

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The information provided could have a considerable importance in helping patients to make treatment-related decisions and comply with the preparation instructions. Giving information, both sensory and procedural, to patients prior to examination could also have beneficial effects, such as reducing anxiety and resulting in the examination being less stressful. Procedural information is defined as an explanation of how and why procedures are carried out, and sensory information as an explanation of sensations that patients may expect during test. (Johnson et al. 1973; Wilson et al. 1982)

O’Connor & Butler G. investigated aspects of patient care during barium enema ...

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