What Matters to Patients When Preparing for a Colonoscopy: A Mixed-Methods Study of Needs and Worry

Background: Colonoscopy is essential for diagnosing, treating, and preventing colorectal cancer, and many patients experience considerable procedure worry. Limited evidence exists on which aspects of preparation and the procedure matter most to patients or how these relate to their Degree-of-Worry (DOW). Understanding these factors is important for improving patient readiness and care quality. This study explores what matters to patients when preparing for colonoscopy, including how they prepare, their perceived readiness, and their DOW. Method: A flash-mob study with a convergent mixed methods was conducted, collecting quantitative and qualitative data simultaneously across multiple sites. Results: Among 203 patients completing the pre-colonoscopy survey and 122 the postcolonoscopy survey, overall preparedness was high (median 9, IQR 8–10), with 86.1% reporting completion of all required activities. Despite this, nearly one-third later wished they had followed instructions more closely, 26.3% would have planned transportation better and 30.3% wished they had prepared mentally, suggesting underestimation of their DOW. Thematic analysis revealed three key themes: (1) Confidence achieved by information and preparation, (2) Trusted professionals as anchors of emotional security, and (3) Maintaining control and achieving closure. Higher DOW was associated with a shift from confidence to fear of serious findings. Conclusion: Although most patients reported high preparedness, many underestimate the emotional impact of colonoscopy, particularly those with high pre-procedure worry. Key preparation priorities include clear information, emotional support and maintaining a sense of control. Addressing these factors may help reduce preprocedure worry, improve patient readiness, and enhance overall care quality.