Trial reportBMJ quality & safety2022
Using a dark logic model to explore adverse effects in audit and feedback: a qualitative study of gaming in colonoscopy.
Trial report in BMJ quality & safety, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Adverse Events Reporting in Digital Interventions Evaluations for Psychosis: A Systematic Literature Search and Individual Level Content Analysis of Adverse Event Reports.Schizophrenia bulletin · 2024Pooled it
- Multicomponent audit and feedback for colonoscopy quality improvement among potentially lower-performing endoscopists.Journal of the Canadian Association of Gastroenterology · 2026Article
- What constitutes risk in implementation research? Perspectives from a qualitative key-informant study.Implementation science communications · 2026Article
- Ethical considerations in implementation research: a scoping review of key principles, unintended consequences, and emerging ethical guidance.Implementation science communications · 2025Review
- Specialist medication monitoring and prescribing in primary care: case study of shared care agreements in Northern England, UK.BMJ open quality · 2025Article
- Hospital at home (virtual wards): developing a logic model and dark logic model.BMC health services research · 2025Article
- Case-mix-adjusted mean number of polyps per 100 procedures: a new candidate gold standard colonoscopy key performance indicator.BMJ open gastroenterology · 2025Article
- Initiatives to increase colonoscopy capacity - is there an impact on polyp detection? A UK National Endoscopy Database analysis.Endoscopy · 2024Article
- Visual identifiers for people with dementia in hospitals: a qualitative study to unravel mechanisms of action for improving quality of care.BMJ quality & safety · 2023Article
- How do healthcare providers use national audit data for improvement?BMC health services research · 2023Article
- How did healthcare professionals define patient engagement in quality management? A survey study.BMC health services research · 2023Article
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAudit and feedback (A&F) interventions improve patient care but may result in unintended consequences. To evaluate plausible harms and maximise benefits, theorisation using logic models can be useful. We aimed to explore the adverse effects of colonoscopy A&F using a feedback intervention theory (FIT) dark logic model before the National Endoscopy Database Automated Performance Reports to Improve Quality Outcomes Trial study.
methodsWe undertook a qualitative study exploring A&F practices in colonoscopy. Interviews were undertaken with endoscopists from six English National Health Service endoscopy centres, purposively sampled for professional background and experience. A thematic framework analysis was performed, mapping paradoxical effects and harms using FIT and the theory of planned behaviour.
resultsData saturation was achieved on the 19th participant, with participants from nursing, surgical and medical backgrounds and a median of 7 years' experience.When performance was below aspirational targets participants were falsely reassured by social comparisons. Participants described confidence as a requirement for colonoscopy. Negative feedback without a plan to improve risked reducing confidence and impeding performance (cognitive interference). Unmet targets increased anxiety and prompted participants to question messages' motives and consider gaming.Participants described inaccurate documentation of subjective measures, including patient comfort, to achieve targets perceived as important. Participants described causing harm from persevering to complete procedures despite patient discomfort and removing insignificant polyps to improve detection rates without benefiting the patient.
conclusionOur dark logic model highlighted that A&F interventions may create both desired and adverse effects. Without a priori theorisation evaluations may disregard potential harms. In colonoscopy, improved patient experience measures may reduce harm. To address cognitive interference the motivation of feedback to support improvement should always be clear, with plans targeting specific behaviours and offering face-to-face support for confidence. TRIAL REGISTRATION NUMBER: ISRCTN11126923.
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