Computer-based patient education is non-inferior to nurse counselling prior to colonoscopy: a multicenter randomized controlled trial

Abstract

Background: Optimal patient education prior to colonoscopy improves adherence to instructions for bowel preparation and leads to cleaner colons. We developed computer based education (CBE) supported by video and 3D animations. We hypothesized that CBE replaces nurse counselling without losing quality of bowel preparation during colonoscopy. Methods: We conducted a prospective, multicenter, endoscopist blinded, non-inferiority randomized controlled trial. The primary outcome was adequate bowel preparation, evaluated using the Boston Bowel Preparation Scale (BBPS). Secondary outcome measures were sickness absence due to outpatient clinic visit, patient anxiety / satisfaction scores and information re-call. We included patients in four endoscopy units (rural, urban, and tertiary). Results: We screened 1035 eligible patients and randomized 845. After evaluation, 684 were included in the intention-to-treat (ITT) group. Subsequently, 497 patients were included in per-protocol (PP) analysis, 217 in nurse counselling and 280 in the CBE group. Baseline characteristics were similarly distributed among groups. In PP analysis, adequate bowel cleansing was achieved in 93.2 % (261/280) of CBE patients, which was non-inferior to nurse counselled patients (94%, 204/217), with a difference of -0.8% [95% CI [- 5.1; 3.5]%. Non-inferiority was confirmed in the ITT population. Sickness absence was significantly more frequent in nurse counselled patients (28.0% vs 4.8%). In CBE patients, 21.5% needed additional information, resulting in 3.0% extra outpatient visits. Conclusion: CBE is non-inferior to nurse counselling in terms of bowel preparation during colonoscopy, with lower patient sickness leave. CBE may serve as an efficient educational tool informing patients before colonoscopy in routine clinical practice.

AGA Clinical Practice Update on Strategies to Improve Quality of Screening and Surveillance Colonoscopy: Expert Review

“…In addition to written instructions, both instructional videos and patient navigation (using trained staff to help patients overcome barriers to care) can improve colonoscopy completion rates and bowel preparation adequacy, particularly in low literacy populations. [30][31][32] Recently, technology interventions, including smartphone applications and text messaging, have been successfully implemented to improve bowel preparation quality, although these tools may not be as universally effective as traditional patient navigation. 33,34 Best Practice Advice 4: Endoscopy units should use high-definition colonoscopes for screening and surveillance colonoscopy.…”

Improving the colorectal cancer care pathway via e-health: a qualitative study among Dutch healthcare providers and managers

“…Scientific studies already support some of the improvement opportunities mentioned by interviewees. For example, the hypothesis that a digital intake would save healthcare providers time is in line with the results of a study showing that, in preparation for an endoscopy, computer-based education was non-inferior to nurse counseling and led to 79% fewer patient visits to the outpatient clinic [ 31 ].…”

Effectiveness of bowel preparation innovative technology instructions (BPITIs) on clinical outcomes among patients undergoing colonoscopy: a systematic review and meta-analysis

“…332 records were excluded because they did not meet the eligibility criteria, leaving 117 potential records for full-text reviews. 84 records of 47 studies met the eligibility criteria and were included in the quantitative synthesis 12 , 16 , 17 , 29 – 72 . (Supplementary S4) 18 records were excluded because of wrong study design (9 records), duplicate records (3 records), wrong publication type (2 records), wrong intervention (3 records), and untrustworthiness findings (1 record).…”

“…However, only the effects of mobile health (mHealth) technologies on colonoscopy preparation outcomes were evaluated in one review. Other innovative technology platforms, such as computer-based, virtual reality videos, and social media platforms, appear to improve bowel cleanliness 13 , 16 , 17 . Moreover, the findings of these two reviews were based on trials published prior to 2020.…”