AbstractsMedical & Health Science

Going trough a colonoscopy and living with inflammatory bowel disease : children's and parents' experiences and evaluation of the bowel cleansing quality prior to colonoscopy

by Vedrana Vejzovic

Institution: Malmö University
Year: 2016
Keywords: Colonoscopy; Inflammatory bowel diseases; Randomised control trial; Content analysis; Phenomenological hermeneutics
Posted: 02/05/2017
Record ID: 2083269
Full text PDF: http://hdl.handle.net/2043/20697


This thesis focuses on children aged 10-18 years with symptoms of, or diagnosed with, inflammatory bowel disease (henceforth referred to as IBD). Before the disease can be diagnosed, a child must undergo several procedures, with colonoscopy as an established investigation, including bowel cleansing, which is crucial for the safe examination of the intestine. The prevalence of paediatric IBD is increasing worldwide, which will augment the number of paediatric colonoscopies. When the recommended laxative polyethylene glycol (PEG) was used for bowel cleansing, the children and their accompanying parents experienced the procedure as difficult due to the large volume of badtasting PEG. Once IBD is diagnosed, the children must undergo lifelong medical treatment, which entails several follow-up colonoscopies. Furthermore, IBD is a chronic illness with an unpredictable activity pattern that can have a negative impact on the children’s quality of life. One of the aims of this thesis was to explore a child/child’s perspective of going through a colonoscopy and child’s perspective of living with IBD. A further aim was to investigate whether sodium picosulphate (NaPico) can be used as an adequate alternative when the bowel is cleansed prior to colonoscopy in children. Three of the studies were interview studies (Papers I, II, & IV) with children and parents as participants. The data from 17 children and 12 parents (Papers I & II) was analysed using content analysis, and a phenomenological hermeneutic method was used when 7 children (Paper IV) were interviewed. The children’s experiences prior to colonoscopy (Paper I) were identified as belonging to an overall theme, A private affair, which could be divided into four categories: Preparing yourself, Mastering the situation, Reluctantly participating, and Feeling emotional support. The result from the parents’ experiences when their child is undergoing an elective colonoscopy was structured into one theme, Charged with conflicting emotions, with three categories: Being forced to force, Losing one’s sense of being a parent, and Standing without guidance (Paper II). The initial findings from these empirical studies undertaken served as a preparation for another study, aimed at comparing the quality of bowel cleansing using either PEG or sodium picosulphate (NaPico) in relation to the tolerability and acceptance of the laxatives among children and their accompanying parents (Paper III). This study was a randomised controlled trial (RCT) that was conducted as an investigator-blinded study within the Department of Paediatrics at a university hospital in Sweden (www.clinicaltrials.gov, identifier NCT02009202). A total of 72 children were randomly placed into one of two groups (PEG or NaPico). The Ottawa Bowel Preparation Quality Scale (OBPQS) was used to evaluate the quality of the bowel cleansing. Two different questionnaires were used to evaluate both the acceptability and the tolerability of the laxatives. In total, 67 protocols were analysed…