Table 2.

Findings from questionnaires and patient interviews: example interview quotes illustrating the practical elements of the Cytosponge procedure

Aspect of cytosponge procedure	Example interview quotes
Convenience and accessibility	Convenient alternative to a procedure in secondary care: ‘(…)from what (the nurse) was saying to me is that (the Cytosponge procedure) takes away that waiting for a hospital appointment, that you can have it done in the (GP) surgery, and if it was me again and, I don’t know, something was not quite right, I wouldn’t hesitate at coming down and having that done. Not at all, not at all.’ (age 60–69, inadequate test result at first appointment)
Staff interpersonal skills	Positive interpersonal skills: ‘The (nurse) who actually did it was really lovely. She really was. She was very calm, very in control and we chatted about different things and she was about to get married and all this sort of thing and it was, we learnt a bit about each other, which was absolutely fine(…)(The procedure is) done very nicely, lovely people, nothing to worry about, go and get it done.’ (age 70–79, negative test result) Procedure explained clearly: ‘I mean if I didn’t understand then I asked to explain it. I think (the staff) were very helpful and very nice, the way they put things over. I mean there was the two of them here and what one didn’t answer, the other one did. No, I think they were very helpful and very kind.’ (age 80 and over, failed swallow)
Perceived technical competence of staff	Staff were skilled at removing sponge: ‘No, it was fine, it was just that and she did really well, she (removed the Cytosponge) as quick as she could be, obviously she had to go slower to get what she needed.’ (age 50–59, negative test result) Patients and inexperienced staff may need more guidance: ‘…the first part of the extraction (of the Cytosponge) was fairly non-event(ful) but then again it did get stuck a bit in my throat(…)And the (practice) nurse had to ask the (research) nurse(…)she just said pull harder. So she pulled harder and it popped out.(…)So I don’t know if positioning the throat in a different way or me being told to hold the throat in a particular angle may have helped but, I mean, I know that sword swallowers, they hold their throat quite straight(…)But there was no advice as to how to hold your head or position your throat and I thought that might have been useful(…)Well to hold the head in a particular position and relax may have helped, I don’t know, it may have got stuck whatever.’ (age 70–79, positive test result)
Swallowing of the Cytosponge	Difficulties due to string and retching: ‘The first time, when I swallowed it, the string seemed to flick around in the back of my throat and it didn’t go down properly, so I was trying to add a bit more water and that, but I couldn’t(…)I was just retching all the time and I couldn’t even get(…)the water in my mouth because I just kept retching all the time(…)And then the second time, it went straight down, straight down. It was marvellous, it went straight down and I thought, oh, I’ve cracked it, so I just kept sipping, and then all of a sudden I think a bit of the string… Like I felt down at the side, and I just went uh, and it just came straight out, just all came straight out altogether.(…)I think it’s the water I drank, it was still lying on my stomach and just brought it straight back up.’ (age 50–59, failed swallow) Swallowing was easy: ‘That swallowing the capsule was simple, there was no… it was easy, it was just a matter of a few mouthfuls of water and that was it.’ (age 50–59, positive test result)
Waiting with Cytosponge in stomach	Waiting was acceptable, especially when there were distractions: ‘But it wasn’t horrendous and for the time that I was there and, you know, and by the time I’d sort of swallowed (the Cytosponge) and answered a few questions, had a little chat and drank some water, it was time for it to come up.’ (age 60–69, negative test result) Mild discomfort: ‘You’re aware of the string being in the throat(…)It was slightly uncomfortable(…)It was making you want to (cough) (…)(but) There was no problem with it.’ (age 60–60, negative test result)
Pulling of the Cytosponge	Experience of pain: ‘It was painful. It was worse than I was expecting(…)the nurse explained it to me afterwards, because afterwards I said to her, I said wow, that was more painful than I was expecting, and she explained that where your muscles will work to push things downwards, obviously, she said, when you’re pulling the sponge up you’re going completely against everything that it’s doing and, do you know, I couldn’t even describe what sort of pain it was, but it was literally… well it felt like a sponge literally was pulling out, you know, but(…)I have to say, it only lasted a few seconds, and once it was out I suppose I had a tickly throat for the rest of the day. Not hurting, just a bit scratchy, tickly, certainly no painkillers, nothing like that. It was just those few seconds of it actually coming out wasn’t pleasant, no.(…)I did come back again (for second appointment following inadequate test result).’ (age 60–69, inadequate test result) Discomfort from gagging/coughing: ‘It was all over in a matter of seconds, but it was when it hit the back of my throat, I did gag, and I started to cough or I had a coughing fit after it was out, I was red hot, you know, I think it was just with gagging, yeah, but it was fine, it was just something that lasted a matter of two seconds.’ (age 50–59, positive test result) No discomfort: ‘It was over and done within a matter of…(…)Woosh, gone.(…)Finished, I didn’t even feel it coming out.’ (age 60–69, negative test result)