A Theory-based Educational Pamphlet With Low-residue Diet Improves Colonoscopy Attendance and Bowel Preparation Quality

Abstract

Goals/Background: Patients who “no-show” for colonoscopy or present with poor bowel preparation waste endoscopic resources and do not receive adequate examinations for colorectal cancer (CRC) screening. Using the Health Belief Model, we modified an existing patient education pamphlet and evaluated its effect on nonattendance rates and bowel preparation quality. Study: We implemented a color patient education pamphlet to target individual perceptions about CRC and changed bowel preparation instructions to include a low-residue diet instead of the previous clear liquid diet. We compared the nonattendance rate over a 2-month period before and after the introduction of the pamphlet, allowing for a washout period during which pamphlet use was inconsistent. We compared the Boston Bowel Preparation Scale (BBPS) in 100 consecutive patients who underwent colonoscopy during each of the 2 periods. Results: Baseline characteristics between the 2 groups were similar, although patients who received the pamphlet were younger (P=0.03). The nonattendance rate was significantly lower in patients who received the pamphlet (13% vs. 21%, P=0.01). The percentage of patients with adequate bowel preparation increased from 82% to 86% after introduction of the pamphlet, although this was not statistically significant (P=0.44). The proportion of patients with a BBPS score of 9 was significantly higher in the pamphlet group (41% vs. 27%, P=0.03). There was no difference in adenoma and sessile serrated adenoma detection rates before and after pamphlet implementation. Conclusions: After implementing a theory-based patient education intervention with a low-residue diet, our absolute rate for colonoscopy nonattendance decreased by 8% and the proportion of patients with a BBPS score of 9 increased by 14%. The Health Belief Model appears to be a useful construct for CRC screening interventions.

Patient Navigation Plus Tailored Digital Video Disc Increases Colorectal Cancer Screening Among Low-Income and Minority Patients Who Did Not Attend a Scheduled Screening Colonoscopy: A Randomized Trial

“…For participants who completed colonoscopy, neither intervention improved quality of bowel preparation, satisfaction with the colonoscopy procedure, nor reduced colonoscopy-related anxiety. Bowel preparation scores were relatively high across all three arms and similar to those reported in other studies [ 66 , 77 , 78 ] so observing significant improvements may not have been possible. In some settings and with some populations, inadequate bowel preparation is a significant problem requiring patients to repeat the preparation and return on another day.…”

Low-residue diet for colonoscopy in veterans: Risk factors for inadequate bowel preparation and patient satisfaction and compliance

“…This replaced the previous bowel preparation instructions, which used a clear liquid diet. Compared to historical controls who underwent a clear liquid diet, those who used the LRD had a statistically non-significant increase in the proportion of individuals with adequate bowel preparation (82% vs. 86%), although the proportion with a maximum Boston Bowel Preparation Scale (BBPS) score of 9 was significantly increased (27% vs. 41%) [9]. In this study, our objectives were to identify risk factors associated with inadequate bowel preparation and to assess patient satisfaction and compliance with the LRD.…”

Personal instruction for patients before colonoscopies could improve bowel preparation quality and increase detection of colorectal adenomas

“…In conclusion, adequate communication with and education of patients are essential for high-quality bowel preparations, which can improve the detection rate of colon lesions. In clinical practice, the most feasible method to improve the patient's understanding and compliance with the bowel preparation methods is to hand out a standard bowel preparation result picture, and a flow chart mainly based on pictures to general patients during appointments (25)(26)(27), provide reeducation via telephone or text messaging (12,28), and send smartphone and social media reminders (29,30) before colonoscopy (31) to improve the quality of bowel preparation and adenoma detection (32). Especially for patients who are assessed as having poor bowel preparation (33,34), such as those with chronic constipation (35,36), should accept personal instruction using the above mentioned methods, or admit to daytime wards if necessary to improve the quality of the bowel preparation for practical colonoscopy examination.…”