Predictors of the experience of a Cytosponge test: analysis of patient survey data from the BEST3 trial
Authors: Ghimire Bhagabati , Landy Rebecca , Maroni Roberta , Smith Samuel G. , Debiram-Beecham Irene , Sasieni Peter D. , Fitzgerald Rebecca C. , Rubin Greg , Walter Fiona M. , Waller Jo ,   BEST3 Consortium, Attwood Stephen , Parmar Max , Delaney Brendan , de Caestecker John , Atkin Wendy , Hackshaw Allan , van Heyningen Charles , Underwood Tim , Stella Alberto , Saxby Charlotte , Lorincz Attila , Turnbull Naomi , Doorbar Jamie , Mannion-Krase Georgia , Kaimi Irene , Kasanicki Mary , Kelleher Stephen , Stockley Louise , Assari Tracy , Kadyan Sonakshi , Hollamby Victoria , Edwards Katie , MacDonald Helen , Shaw Viv , Leishman Heather , Roper Holly , McCloskey Kate , Jung Helen , Phillips Alex , Masjak-Newman Gosia , Fell Kim , Collins Helen , Zolle Olga , McGlone Pauline , Crabb Tania , Merrin Lauren , Cross Martine , Jones Alex , Simpson Tom , Murray Emma , Perugia Andrew , Thompson Marie , Dumbleton Jen , Morar Monique , Frowd Nadia , Hardcastle Antonia , Carmichael Debbie , Maxton Fiona , Farnworth Frances , Baddeley Elaine , Offman Judith 
Published: January 2023

Abstract
Background
The Cytosponge is a cell-collection device, which, coupled with a test for trefoil factor 3 (TFF3), can be used to diagnose Barrett’s oesophagus, a precursor condition to oesophageal adenocarcinoma. BEST3, a large pragmatic, randomised, controlled trial, investigated whether offering the Cytosponge-TFF3 test would increase detection of Barrett’s. Overall, participants reported mostly positive experiences. This study reports the factors associated with the least positive experience.

Methods
Patient experience was assessed using the Inventory to Assess Patient Satisfaction (IAPS), a 22-item questionnaire, completed 7–14 days after the Cytosponge test.

Study cohort
All BEST3 participants who answered ≥ 15 items of the IAPS (N = 1458).

Statistical analysis
A mean IAPS score between 1 and 5 (5 indicates most negative experience) was calculated for each individual. ‘Least positive’ experience was defined according to the 90th percentile. 167 (11.4%) individuals with a mean IAPS score of ≥ 2.32 were included in the ‘least positive’ category and compared with the rest of the cohort. Eleven patient characteristics and one procedure-specific factor were assessed as potential predictors of the least positive experience. Multivariable logistic regression analysis using backwards selection was conducted to identify factors independently associated with the least positive experience and with failed swallow at first attempt, one of the strongest predictors of least positive experience.

Results
The majority of responders had a positive experience, with an overall median IAPS score of 1.7 (IQR 1.5–2.1). High (OR = 3.01, 95% CI 2.03–4.46, p < 0.001) or very high (OR = 4.56, 95% CI 2.71–7.66, p < 0.001) anxiety (relative to low/normal anxiety) and a failed swallow at the first attempt (OR = 3.37, 95% CI 2.14–5.30, p < 0.001) were highly significant predictors of the least positive patient experience in multivariable analyses. Additionally, sex (p = 0.036), height (p = 0.032), alcohol intake (p = 0.011) and education level (p = 0.036) were identified as statistically significant predictors.

Conclusion
We have identified factors which predict patient experience. Identifying anxiety ahead of the procedure and discussing particular concerns with patients or giving them tips to help with swallowing the capsule might help improve their experience.
Trial registration ISRCTN68382401.