"That's what sets you at ease:" A qualitative analysis of patient preferences during anorectal exams

Increased attention is being paid to sensitive but necessary medical examinations, but the literature on guidelines for the anorectal exam remains limited. We performed a qualitative investigation of the patient experience to identify best practice recommendations from the patient's perspective for practitioners conducting the anorectal exam.

We conducted semi-structured interviews with patients aged 18 and older who had received at least one anorectal examination at the University of Chicago Medicine, Colon & Rectal Surgery clinic. The interviews investigated contextual aspects of the anorectal examination, such as the urgency of the visit, the clinical environment, and patients' encounters with the anorectal examination. We sought recommendations on how to improve the examination experience. Interviews were digitally recorded and transcribed. Content analysis was performed by two independent researchers. Interviews were obtained until thematic saturation was reached.

Twenty-three participants (48 ​% female, 48 ​% first-time examinees) completed interviews. Regarding examination preparation, most participants preferred obtaining exam information directly from their providers. Without prompting, many female patients expressed a preference for a female provider. Most exam logistics were non-contributory to the patient experience (exam room, gown, instrument use, etc.). Most patients did not mind chaperones if they were additionally serving another role (i.e. assisting in the examination). When chaperones were explicitly offered, every patient declined.

Recommendations included (1) establishing rapport and educating before the examination, (2) building practices to orient patients, (3) explaining procedural steps and eliciting continuous feedback, and (4) implementing routine use of chaperones instead of asking patients to opt-in, when possible. These findings emphasize the need for best practice guidelines and educational interventions to equip healthcare providers for conducting anorectal examinations.