Analysis of factors and pathways influencing patients’ level of worry about painless gastrointestinal endoscopy

To investigate the level of worry in patients undergoing painless gastrointestinal endoscopy and to identify the factors and pathways that influence this worry. This cross-sectional study collected data between March and April 2024. A convenience sampling method was employed to select 477 patients scheduled for painless gastrointestinal endoscopy from a tertiary general hospital in Xiamen, China. The survey employed a self-administered general information questionnaire, along with validated scales measuring worry levels (WLs), psychological resilience (PR), and social support (SS). A multiple logistic regression analysis was used to investigate the factors influencing the level of worry. Model 4 of the PROCESS macro (v3.3) was used to analyze the mediating effects of PR on the relationship between SS and WLs. Worry scores were moderate (median score: 36, IQR: 25-47, on a 0-75 scale). Multivariate analysis revealed distinct predictors for different WLs. Rural residence was significantly associated with all three worry levels. Patients undergoing endoscopy for rechecking showed higher odds of mild worry, while those with fecal abnormalities and those enrolled in Urban Employee Basic Medical Insurance had increased odds of moderate worry. Lower monthly income (<¥ 4000) was associated with moderate worry. Younger age (<40 years) was the strongest predictor for severe worry. History of unsedated endoscopy, abdominal discomfort, and Urban Employee Basic Medical Insurance were also significant predictors for severe worry. Furthermore, PR mediated the relationship between SS and worry. Individualized communication and support plans should be developed based on different symptoms, medical histories, and specific patient characteristics. Particular attention should be paid to rural residents, younger patients (<40 years), those with lower incomes, patients experiencing abdominal discomfort or fecal abnormalities, and those with previous unsedated endoscopy experience. The type of medical insurance (Urban Employee Basic Medical Insurance) should also be considered as it was associated with both moderate and severe WLs.