An Automated Text Message Navigation Program Improves the Show Rate for Outpatient Colonoscopy

Mahmud, Nadim; Doshi, Sahil; Coniglio, Mary; Clermont, Michelle P.; Bernard, Donna; Reitz, Catherine; Khungar, Vandana; Asch, David A.; Mehta, Shivan J.

doi:10.1177/1090198119869964

Cited by 18 publications

(43 citation statements)

References 13 publications

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“…The results of randomized clinical trials often do not confirm pilot findings; in the pilot study 11 for this trial, we observed a significant increase in appointment adherence among patients receiving a texting intervention. There may be several reasons for this discrepancy, some of which represent a type of generalizability bias that may occur in transition from pilot to randomized clinical trial.…”

Section: Discussioncontrasting

confidence: 75%

“…We conducted a quality improvement pilot study that evaluated the feasibility of a 1-week text messaging protocol for patients who were scheduled for outpatient colonoscopy. 11 Among 21 patients enrolled in the pilot study, there was high user acceptability and higher colonoscopy attendance rates compared with baseline values at an urban academic endoscopy center. The aim of this study was to evaluate the effect of an automated text message–based intervention on appointment adherence and bowel preparation quality in a larger, randomized setting.…”

Section: Introductionmentioning

confidence: 97%

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Effect of Text Messaging on Bowel Preparation and Appointment Attendance for Outpatient Colonoscopy

et al. 2021

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IMPORTANCEOutpatient colonoscopy is important for colorectal cancer screening. However, nonadherence and poor bowel preparation are common. OBJECTIVE To determine if an automated text messaging intervention with a focus on informational and reminder functions could improve attendance rates and bowel preparation quality for outpatient colonoscopy. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial was conducted in an endoscopy center at an urban academic medical center. Adult patients scheduled for outpatient colonoscopy between January and September 2019 were enrolled by telephone call (early phase) or by automated text message (late phase). Data were analyzed from October 2019 to January 2020. INTERVENTIONSAfter enrollment, patients were randomized in a 1:1 ratio to usual care (ie, written instructions and nurse telephone call) or to the intervention (ie, usual care plus an automated series of 9 educational or reminder text messages in the week prior to scheduled colonoscopy). MAIN OUTCOMES AND MEASURESThe primary outcome was appointment attendance rate with good or excellent bowel preparation. Secondary outcomes included appointment attendance rate, bowel preparation quality (poor or inadequate, fair or adequate, and good or excellent), and cancellation lead time (in days). RESULTS Among 753 patients included and randomized in the trial (median [interquartile range]age, 56 [49-64] years; 364 [48.3%] men; 429 [57.2%] Black), 367 patients were randomized to the intervention group and 386 patients were randomized to the control group. There was no significant difference in the primary outcome between groups (patients attending appointments with good or excellent bowel preparation: intervention, 195 patients [53.1%]; control, 210 patients [54.4%]; P = .73), including when stratified by early or late phase enrollment groups. Similarly, there were no significant differences in secondary outcomes. CONCLUSIONS AND RELEVANCEThis randomized clinical trial found no significant difference in appointment attendance or bowel preparation quality with an automated text messaging intervention compared with the usual care control. Future work could optimize the content and delivery of text message interventions or identify patient subgroups that may benefit from this approach.

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Section: Discussioncontrasting

confidence: 75%

Section: Introductionmentioning

confidence: 97%

Effect of Text Messaging on Bowel Preparation and Appointment Attendance for Outpatient Colonoscopy

et al. 2021

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“…In our case, there were also time windows for submission so that only a single piece of information (ie, BP or medication adherence) was being collected at a time. This simplified approach makes automated texting technically feasible and approachable across many clinical settings [ 17 , 22 - 24 ]. Because texting is a largely unrestricted platform, automating a response to correct unstandardized submissions is a way to train users to conform with the program.…”

Section: Discussionmentioning

confidence: 99%

“…In the original study, scheduled automated text messages were used to (1) monitor each patient’s BP measurements over time, (2) provide intermittent encouragement for engaging behavior, and (3) monitor BP medication adherence. Texts were sent through Way to Health, a Health Insurance Portability and Accountability Act–compliant, bidirectional, automated text communication platform used to engage with patients for research studies and clinical care delivery [ 17 , 18 ]. Patients in the original study received a variety of outbound texts including information about the study and upcoming in-person study visits.…”

Section: Methodsmentioning

confidence: 99%

Patient Interaction Phenotypes With an Automated Remote Hypertension Monitoring Program and Their Association With Blood Pressure Control: Observational Study

Davoudi¹,

Lee²,

Chivers³

et al. 2020

J Med Internet Res

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Background Automated texting platforms have emerged as a tool to facilitate communication between patients and health care providers with variable effects on achieving target blood pressure (BP). Understanding differences in the way patients interact with these communication platforms can inform their use and design for hypertension management. Objective Our primary aim was to explore the unique phenotypes of patient interactions with an automated text messaging platform for BP monitoring. Our secondary aim was to estimate associations between interaction phenotypes and BP control. Methods This study was a secondary analysis of data from a randomized controlled trial for adults with poorly controlled hypertension. A total of 201 patients with established primary care were assigned to the automated texting platform; messages exchanged throughout the 4-month program were analyzed. We used the k-means clustering algorithm to characterize two different interaction phenotypes: program conformity and engagement style. First, we identified unique clusters signifying differences in program conformity based on the frequency over time of error alerts, which were generated to patients when they deviated from the requested text message format (eg, ###/## for BP). Second, we explored overall engagement styles, defined by error alerts and responsiveness to text prompts, unprompted messages, and word count averages. Finally, we applied the chi-square test to identify associations between each interaction phenotype and achieving the target BP. Results We observed 3 categories of program conformity based on their frequency of error alerts: those who immediately and consistently submitted texts without system errors (perfect users, 51/201), those who did so after an initial learning period (adaptive users, 66/201), and those who consistently submitted messages generating errors to the platform (nonadaptive users, 38/201). Next, we observed 3 categories of engagement style: the enthusiast, who tended to submit unprompted messages with high word counts (17/155); the student, who inconsistently engaged (35/155); and the minimalist, who engaged only when prompted (103/155). Of all 6 phenotypes, we observed a statistically significant association between patients demonstrating the minimalist communication style (high adherence, few unprompted messages, limited information sharing) and achieving target BP (P<.001). Conclusions We identified unique interaction phenotypes among patients engaging with an automated text message platform for remote BP monitoring. Only the minimalist communication style was associated with achieving target BP. Identifying and understanding interaction phenotypes may be useful for tailoring future automated texting interactions and designing future interventions to achieve better BP control.

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“…For example, a pilot study by these authors of a nearly identical text intervention yielded improved colonoscopy show rates. 4 Additionally, numerous other studies have found text messaging to be effective for appointment attendance. 5 Second, with colonoscopies already in high demand (and demand expected to increase), interventions to reduce nonattendance are critically needed.…”

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confidence: 99%

Texting to Improve Colonoscopy Preparation and Adherence Needs More Study

Clancy

Dominitz

2021

JAMA Netw Open

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This study by Mahmud and colleagues 1 describes results of their randomized clinical trial to determine whether a text message intervention could reduce colonoscopy nonattendance and improve bowel preparation quality. Among 753 patients in Philadelphia, Pennsylvania, undergoing outpatient colonoscopy, the intervention failed to improve appointment adherence as well as bowel preparation quality compared with usual care. Overall, 195 of 387 patients (53.1%) receiving the intervention texts and 210 of 386 patients (54.4%) in the usual care control group kept their appointment with either good or excellent bowel preparation. 1 Furthermore, no significant differences were found in any secondary outcomes, such as individual components of appointment adherence, bowel preparation quality, colonoscopy reschedule rates, and cancellation lead time. 1 Annually, an estimated 15 million screening, surveillance, and diagnostic colonoscopies are performed annually in the United States, 2 associated with a decline in colorectal cancer mortality, the second leading cause of cancer-related death. 3 Colonoscopies are the most frequently used colorectal cancer screening test in the United States.Although the findings in the study by Mahmud et al 1 were negative, they inform future research by highlighting critical issues. First, by comparing texting with previous studies in which texting (or a similar intervention) was effective, we could better understand the intervention's key aspects (and/or study population) and work toward future effectiveness. For example, a pilot study by these authors of a nearly identical text intervention yielded improved colonoscopy show rates. 4 Additionally, numerous other studies have found text messaging to be effective for appointment attendance. 5 Second, with colonoscopies already in high demand (and demand expected to increase), interventions to reduce nonattendance are critically needed. This expectation is partly owing to recent recommendations that the starting age for colorectal cancer screening be lowered from age 50 years to age 45 years. 3

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An Automated Text Message Navigation Program Improves the Show Rate for Outpatient Colonoscopy

Cited by 18 publications

References 13 publications

Effect of Text Messaging on Bowel Preparation and Appointment Attendance for Outpatient Colonoscopy

Effect of Text Messaging on Bowel Preparation and Appointment Attendance for Outpatient Colonoscopy

Patient Interaction Phenotypes With an Automated Remote Hypertension Monitoring Program and Their Association With Blood Pressure Control: Observational Study

Texting to Improve Colonoscopy Preparation and Adherence Needs More Study

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