Gastroenterology · Medical Literature
[Effects of a structured language intervention based on predictive coding theory on patient experience and completion status of conventional gastroscopy].
Abstract
Objective: To evaluate the effects of a structured language intervention based on predictive coding theory (PCT) on the examination experience and completion status of patients undergoing conventional gastroscopy. Methods: A randomized controlled trial was conducted. The adult patients undergoing conventional gastroscopy at the First Medical Center of the Chinese PLA General Hospital between June and December 2025 were prospectively enrolled. The patients were randomly assigned to the intervention group and the control group using the random number table method. The control group received standard preoperative and intraoperative verbal guidance, whereas the intervention group received a PCT-based structured language intervention. The primary outcome was the discomfort score, assessed by the visual analogue scale (VAS) immediately after gastroscopy, while the secondary outcomes were endoscopic operation time, endoscopic operation termination rate, and the proportion of patients willing to undergo regular gastroscopy again. Independent samples t-test, Mann-Whitney U test or χ² test were used to compare the primary and secondary outcomes between the two groups. Results: A total of 150 patients were enrolled, including 83 males and 67 females, aged (49±3) years. The intervention group and control group each included 75 patients. Compared to the control group, the intervention group had a significantly lower VAS discomfort score [3 (3, 4) vs 6 (5, 7), P<0.001], shorter endoscopic operation duration [(9.7±0.9) vs (13.0±1.2) min, P<0.001], and a higher proportion of patients willing to repeat gastroscopy [92.0% (69/75) vs 68.0% (51/75), P<0.001]. There was no statistically significant difference in procedure termination rates between the two groups [1.3% (1/75) vs 4.0% (3/75), P=0.311]. Conclusion: The structured language intervention based on PCT can reduce patients' discomfort, shorten operation duration, and promote willingness for repeated gastroscopy.
Clinical relevance
Conventional (unsedated) gastroscopy is associated with significant patient discomfort, procedural non-compliance, and reluctance to undergo repeat surveillance, representing a major barrier to upper GI cancer screening programs—particularly in health systems where propofol sedation is not universally available or cost-effective. This RCT addresses whether a structured, theory-driven verbal intervention can meaningfully improve the patient experience without pharmacological adjuncts. The findings are immediately relevant to endoscopists, gastroenterology nurses, and procedure unit administrators seeking low-cost, scalable strategies to optimize conventional gastroscopy tolerance and completion.
Key findings
1. Discomfort (primary outcome): The PCT-based intervention group demonstrated a significantly lower post-procedural VAS discomfort score compared to controls (median 3 [IQR 3–4] vs. 6 [IQR 5–7]; P<0.001), representing a clinically meaningful 3-point median reduction on a standard 0–10 VAS scale. 2. Procedural efficiency: Endoscopic operation duration was significantly shorter in the intervention group compared to controls (9.7±0.9 min vs. 13.0±1.2 min; P<0.001), a mean reduction of approximately 3.3 minutes per procedure. 3. Patient willingness for repeat endoscopy: A significantly higher proportion of intervention-group patients expressed willingness to undergo repeat gastroscopy (92.0% [69/75] vs. 68.0% [51/75]; P<0.001), yielding an absolute risk increase of 24.0 percentage points (NNT ≈ 4.2 for one additional patient willing to comply with surveillance). 4. Procedure termination rate: There was no statistically significant difference in early procedure termination between the intervention and control groups (1.3% [1/75] vs. 4.0% [3/75]; P=0.311), though the study was likely underpowered to detect a difference in this low-frequency outcome. 5. Study design and population: This was a prospective RCT (n=150; 83 male, 67 female; mean age 49±3 years) conducted at a single tertiary center (Chinese PLA General Hospital), with balanced allocation (75 per arm) via random number table methodology. 6. Intervention structure: The experimental arm received a PCT-based structured language protocol during the pre- and intra-procedural phases, in contrast to standard verbal guidance alone in controls; no pharmacological sedation or anxiolytics were described as components of the intervention.
Practice implications
Endoscopy units performing conventional (unsedated) gastroscopy should consider implementing a standardized, PCT-based verbal communication protocol delivered by trained endoscopists or nursing staff during both the pre-procedural preparation and active intubation/examination phases, as this approach produced a clinically significant reduction in discomfort and a ~3-minute decrease in procedure time without additional pharmacological risk or cost. Patient selection for this intervention appears broadly applicable to adult outpatients undergoing routine diagnostic gastroscopy, but is particularly high-yield for individuals who are anxious, surveillance-averse, or in settings where sedation is unavailable; the near-fourfold improvement in repeat-procedure willingness (NNT ~4) has direct implications for upper GI cancer screening adherence. Institutions should develop and validate site-specific PCT-based language scripts, invest in structured staff training for their delivery, and prospectively audit discomfort scores and re-examination rates as quality metrics, while awaiting multicenter replication to confirm generalizability beyond this single-center Chinese cohort.