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Questions were informed by the theoretical frame of trauma-informed care and fieldwork and collaborative discussions with endoscopists, multidisciplinary staff, and patients. Patients were recruited through purposive sampling to reflect a range of indications for colonoscopy, demographics, and health backgrounds. Interviews and data analysis were conducted in overlapping phases to ensure a diversity of perspectives. Thematic analysis was used to identify shared patterns across the data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Nine patients completed interviews, and analysis generated the central dialectic \u201cit\u2019s a tool, it\u2019s got hardships,\u201d reflecting a shared belief that colonoscopies are both stressful and important to one\u2019s health. Within this uniting concept, we identified themes of patient, provider, and process factors that have the potential to reduce or promote distress. Subthemes related to patients\u2019 past experiences\/expectations, coping, and access to support; providers\u2019 communication and behavior; and process factors including prep\/wait times, sedation and anesthesia, and team-based care. Factors that buffered against distress included perceived trust, transparency, and confidence; positive expectations rooted in prior healthcare experiences; flexible coping and feeling supported. Factors that contributed to increased vulnerability included having a minoritized identity, a history of past medical trauma, and uncertainty in communication and the colonoscopy process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Efforts to improve the colonoscopy experience should continue to address the interplay of these complex factors. Given that identification of those at the highest risk for distress may not always be possible, we recommend a universal trauma-informed approach and provide specific suggestions for implementation in endoscopy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17562848251346250","type":"journal-article","created":{"date-parts":[[2025,6,21]],"date-time":"2025-06-21T09:42:53Z","timestamp":1750498973000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["\u201cIt\u2019s a tool, it\u2019s got hardships\u201d: a qualitative study of patient experience of colonoscopy and implications for trauma-informed care"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0335-8935","authenticated-orcid":false,"given":"Katrina S.","family":"Hacker","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Curley","sequence":"additional","affiliation":[{"name":"Center for Digestive Health, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2240-6605","authenticated-orcid":false,"given":"Corey A.","family":"Siegel","sequence":"additional","affiliation":[{"name":"Center for Digestive Health, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6498-3729","authenticated-orcid":false,"given":"Jessica K.","family":"Salwen-Deremer","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Center for Digestive Health, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,6,21]]},"reference":[{"key":"e_1_3_4_2_2","first-page":"123","volume-title":"The burden of digestive diseases in the United States","author":"Ruhl CE","year":"2008","unstructured":"Ruhl CE, Everhart JE. 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