Should you save the best for last?

Colonoscopy is a screening procedure commonly used to identify Colorectal cancer. People could be reluctant to undergo this procedure because it is painful. A study by Redelmeier, Katz, and Kahneman ran an experiment to see if there was a possibility to reduce a patient's perception of how painful the Colonoscopy procedure was. If you can't find the link between Colonoscopy and the title of this article,  wait till the end. 

Outpatients who would undergo the procedure between November 1994 and December 1995 in a particular hospital, were part of the study. Patients could receive either the Standard care or the Modified care. The Standard care was the standard procedure used by the Hospital. The modified care extended the duration of the standard procedure by about 3 minutes extra. In the extended duration, the tip of the Colonoscope (the instrument used), remained inside the person's body although it didn't function. The extended duration was less painful than the standard procedure. 

The experiment used a procedure called Double Blind. In this, both the participants and the researchers are not informed if the patient is to get the standard care or the modified care.  Participants were handed a sealed envelope with instructions specifying the type of care that a patient should receive. This envelope was opened by the surgeon only in the final stage. Delaying disclosure until the end ensured that the clinicians would not alter (consciously or unconsciously) their procedures. Patients were not told if an intervention was initiated as this might alter their judgments of pain. 

After the procedure, a set of scales was used for patients to report their total discomfort from the procedure. When comparing the reported discomfort of patients from the two types of procedure, it was found that patients who got the modified procedure, remembered the procedure as being less painful, as compared to patients who received the standard procedure. This is  not what we might expect. Essentially, a longer procedure makes patients think they felt less pain than those with a shorted procedure, although they probably felt the same pain (if not more).  This can be explained by the fact  that when people evaluate pain in retrospect, they give a higher weight to the ending. So a less painful ending might make the patient think that the entire procedure was less painful.

Turns out that there is some wisdom in the adage "save the best for last. "

References
Redelmeier, Donald A., Joel Katz, and Daniel Kahneman. "Memories of colonoscopy: a randomized trial." Pain 104, no. 1 (2003): 187-194.


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