Acceptability of postpolypectomy surveillance colonoscopy: a qualitative study of patients and healthcare professionals in Scotland

Background Postpolypectomy surveillance colonoscopy reduces colorectal cancer risk but engagement and delivery are variable. While colonoscopy acceptability has been explored in diagnostic and screening contexts, little is known about the acceptability of repeat procedures from the perspectives of both patients and healthcare professionals. Methods A qualitative study comprising semistructured interviews with 15 patients awaiting postpolypectomy surveillance and 11 healthcare professionals purposively sampled from across the postpolypectomy surveillance service. Interviews were analysed inductively using reflexive thematic analysis, with input from a patient and public involvement group. Results Four themes represented patient acceptability: (1) A challenging regimen with high stakes —bowel preparation, discomfort and anxiety had made past colonoscopy burdensome, combined with a need to know the outcome; (2) Faced the unknown; learned for the future —greater confidence about surveillance contrasted with past uncertainty; (3) Staff professionalism and warmth provided comfort —interpersonal care supported acceptability; and (4) Surveillance necessity outweighs challenges . Healthcare professionals described five themes: (1) Awareness of unnecessary or low-value surveillance ; (2) Frustration with inefficiencies and delays —exacerbated by capacity and resource constraints; (3) Tension between need for consistency vs clinical judgement ; (4) Human toll of surveillance including emotional and practical strain; and (5) Optimism about improvement . Conclusion Postpolypectomy surveillance colonoscopy acceptability is shaped by experiential, professional and systemic factors. Patients emphasised the balance between burden and necessity, while acceptability to professionals involved concepts of value, consistency and personal impact. Addressing these perspectives will be useful for refining current practice and implementing new risk-based surveillance approaches.