Fear of pain and discomfort remains one of the leading barriers to colonoscopy attendance, contributing to delayed diagnosis and reduced colorectal cancer detection rates. While sedation and advanced endoscopic systems can enhance patient comfort, these resources are not universally available—particularly in low- and middle-income settings. Low-cost, non-pharmacological interventions such as music and cognitive distraction may offer a practical alternative to improve patient experience.

Aim

To assess the impact of music and smartphone-based task distraction on physiological markers of pain and patient-reported comfort during colonoscopy in a Moroccan tertiary centre.

A prospective three-arm observational study was conducted at CHU Mohammed VI Marrakech between January and October 2024.Consecutive adult patients undergoing elective colonoscopy were enrolled and allocated to one of three groups:

Arm A: standard colonoscopy; Arm B: colonoscopy with music; Arm C: colonoscopy with smartphone task distraction

Real-time heart rate and respiratory rate were recorded using a wearable monitor. Patient satisfaction, perceived discomfort, sedation use, and procedural difficulty were documented. Data were analysed using ANOVA and generalized estimating equations.

A total of 96 patients were included in the interim analysis (32 per arm; 49% female; mean age 49.2 years). Baseline demographic and clinical characteristics were comparable across all three groups.

1. Heart rate (mean HR)

Real-time mean heart rate differed between groups:, Arm A – Standard colonoscopy: 85.7 bpm (SD 22.9), Arm B – Music: 79.4 bpm (SD 20.1), Arm C – Smartphone task distraction: 76.1 bpm (SD 19.4)

ANOVA showed a significant difference between groups (p = 0.03), with the lowest HR observed in Arm C.

2. Respiratory rate (mean RR)

Mean respiratory rate followed a similar pattern: Arm A: 13.9/min (SD 6.0); Arm B: 13.1/min (SD 5.4); Arm C: 12.8/min (SD 5.7)

Group comparison reached significance (p = 0.04).

3. Patient comfort

Patient-reported pain and discomfort scores (0–10 scale) were lower in the intervention arms:

Pain: Arm A 5.6 vs Arm B 4.1 vs Arm C 3.7, Discomfort: Arm A 6.2 vs Arm B 4.5 vs Arm C 3.9, Overall p < 0.01.

4. Satisfaction

A large majority of patients in intervention groups reported high satisfaction: Arm A: 63%, Arm B: 91%, Arm C: 94%

Almost all patients in Arms B and C stated they would choose the same method again.

5. Sedation and procedural difficulty

Sedation rates were similar across groups (25–30%, p = NS).Endoscopist-rated procedural difficulty did not differ significantly between arms.

6. Safety

No intervention-related adverse events were recorded. Completion rates (cecal intubation) were high across all groups (>95%).

In this Moroccan monocentric cohort, music and smartphone task distraction significantly improved objective and subjective measures of comfort during colonoscopy. These simple, low-cost interventions offer a practical strategy to enhance patient experience, increase acceptance of colonoscopy, and potentially improve adherence to colorectal cancer screening programmes.Final results from the ongoing larger cohort will help refine implementation strategies in routine endoscopy practice.