Table 3

Harmful effects—documentation subthemes and illustrative quotations

SubthemeQuotation (Participant (P))
1. FIT gaming indirect harm: fudge withdrawal time‘That’s always one of the things that you worry about is are you just going to take off a load of rectal polyps in the same way that you could just withdraw and sit in the rectum for five minutes, couldn't you, and then say your withdrawal times.’ (P3)
‘When it comes to withdrawal times … some people will say, “Start the clock,” and then [the nurses] say well, “Are you actually at the caecum?” … some endoscopists who had then kind of hung around the rectum for a couple of minutes saying, “I’m staying here around the rectum for a couple of minutes because I have to”.’ (P5)
‘Of course, you have to be wary of withdrawal time. I hear anecdotally from the nurses that: “So and so has a long withdrawal time but eight minutes of that [they are] sitting in the rectum talking”.’ (P19)
2. FIT gaming indirect harm: conversion to sigmoidoscopy‘People have changed what was an intended colonoscopy to a flexi sig because of poor prep or that’s as far as they’ve got and you can see the nursing documentation, the original referral.’ (P7)
‘I know some people kind of falsify figures and I always put if it’s a colon it’s a colon. If it’s a failed colon it’s a failed colon. It’s not a sigmoidoscopy it’s a colonoscopy and I know that people do not always follow that… That skews the figures as well… It’s very common.’ (P10)
3. FIT gaming indirect harm: bowel preparation‘I do understand that some endoscopists could potentially fudge their figures and are feeling tired, “oh poor bowel prep, let’s just come out”. So I do understand that, so I don’t know what the answer is but it is hard because you do get poor bowel preps.’ (P12)
‘My caecal intubation rate is lower than it should be perhaps, mainly because of poor bowel prep.’ (P2)
‘Well part of the problem with [detection rates] is some that will be down to poor prep. I can think of a number of cases recently where the prep in the right colon is fairly smeary. If you had better prep, you’d probably have [detection].’ (P19)
4. FIT gaming—TPB control belief: comfort‘There’s no consistency with regard to whether the data is the endoscopist’s personal view or whether it’s they have taken feedback from the nurses in the room talking to the patient.’ (P5)
‘I was signing off a colonoscopy portfolio for somebody for JAG certification and I just said, “You’ve done your 230 or whatever.” I said, “Why is everyone of your patients comfortable?” … I hadn’t done individual training with this person. And I just thought, “Oh my God. What on earth.” They said, “Well that’s what the consultant’s put on the thing.”… But it just wasn’t important to him. I just thought, oh my goodness, throughout his training, where has that perception come from. And I was really worried … I said, “I’m not signing you off until you go back and we do some more work and have a look at sort of these comfort scores with patients and whatever.” But it was through no fault of their own in some ways but I was absolutely horrified.’ (P7)
‘Comfort has been such a difficult thing … every unit does it differently, newer nurses will call your patients as higher discomfort because they’ve never seen the procedures before …we’ve got everybody using different nursing scales.’ (P7)
  • FIT, feedback intervention theory; JAG, Joint Advisory Group; TPB, theory of planned behaviour.