Enhanced education for bowel preparation before colonoscopy: A state-of-the-art review

Navigating Bowel Preparation for Colonoscopy: A Comprehensive Overview

Colorectal cancer (CRC) is the third most common cancer in the United States. Early detection through colonoscopy significantly improves survival rates. Detecting colon polyps depends on the quality of bowel preparation. However, inadequate bowel preparation remains a significant issue in clinical practice. Efforts to address this challenge have led to the development of bowel preparation regimens emphasizing efficacy, tolerability, and safety. Bowel preparation options can be categorized by their osmotic and volume properties. Isosmotic solutions based on polyethylene glycol-electrolyte lavage solutions (PEG-ELS) are available in both low-volume PEG-ELS with ascorbic acid (PEG-Asc) (e.g., MoviPrep, PLENVU) and high-volume formulations (e.g., GoLYTELY, CoLyte), as well as sulfate-free high-volume PEG-ELS formulations (SF-PEG-ELS). Hyperosmotic solutions include oral sulfate solution (OSS) (e.g., SUPREP), sodium phosphate tablets (NaP) (e.g., OsmoPrep), oral sulfate tablets (OST) (e.g., SUTAB), flavored PEG with sulfate salts (FPSS) (e.g., SUFLAVE), and magnesium citrate. Hypoosmotic solutions consist of PEG-sports drink (PEG-SD). In addition, combination solutions are available, such as sodium picosulfate with magnesium citrate (SPMC) with laxatives (e.g., CLENPIQ), and OSS with SF-PEG-ELS (Suclear). Each regimen differs in terms of cost, volume, taste, contraindications, and potential adverse effects. Therefore, clinicians must carefully evaluate each patient to determine the most suitable regimen for their patients.

Think-Aloud Testing of a Companion App for Colonoscopy Examinations: Usability Study

Background

Colonoscopies are vital for initial screening, follow-ups, surveillance of neoplasia, and assessing symptoms such as rectal bleeding. Successful colonoscopies require thorough colon preparation, but up to 25% fail due to poor preparation. This can lead to longer procedures, repeat colonoscopies, inconvenience, poorer health outcomes, and higher costs. eHealth tools can enhance bowel preparation and potentially reduce the need for repeat procedures.

Objective

This usability study aimed to identify strengths and weaknesses in a prototype companion app for colonoscopy examinations. The objective was to obtain in-depth insights into the app's usability, ease of use, and content comprehension, with the aim of refining the tool to effectively fulfill its intended purpose, guided by feedback from potential users.

Methods

From February to August 2024, we conducted a qualitative study using the think-aloud procedure. Each session involved 6 tasks and a semistructured interview to delve deeper into participants' task experiences. All think-aloud sessions and interviews were recorded. Quantitative usability questions were analyzed using Microsoft Excel, while qualitative data underwent coding and analysis based on thematic analysis principles.

Results

In total, 17 individuals, all smartphone users, participated in this study. Participants were recruited from 1 hospital, 1 private clinic, and 1 patient organization in Switzerland. The study found that participants rated the app's usability metrics positively, with an overall mean rating of ease of use at 4.29 (SD 0.59), usefulness at 4.53 (SD 0.72), and comprehensibility at 4.29 (SD 0.92). For the individual features, the mean ratings for ease of use were between 4 and 4.65, usefulness ranged from 4.35 to 4.82, and comprehensibility received ratings between 4.29 and 4.53, all measured on a 5-point scale, where 1 represented low agreement and 5 indicated high agreement. Additionally, 100% of participants indicated they will or may use the app if they require a colonoscopy examination. Participants highlighted the need for reminders and alerts in the week leading up to the colonoscopy, along with tailored content, simplified language, and visual aids.

Conclusions

The app prototype demonstrated favorable results with the majority of participants, and the testing process enabled the prompt identification and resolution of usability issues. The next phase will prioritize and assess potential improvements based on urgency and feasibility to guide a focused development plan. Usability testing highlighted features such as push notifications and personalized content as top priorities for participants, making them key areas for immediate attention. Moving forward, the app has the potential to function effectively as a companion app for colonoscopy examinations. To achieve this, further studies with a larger sample in real-world settings will be crucial.

Using a Mobile Health App (ColonClean) to Enhance the Effectiveness of Bowel Preparation: Development and Usability Study

Background

Colonoscopy is the standard diagnostic method for colorectal cancer. Patients usually receive written and verbal instructions for bowel preparation (BP) before the procedure. Failure to understand the importance of BP can lead to inadequate BP in 25%-30% of patients. The quality of BP impacts the success of colonoscopy in diagnostic yield and adenoma detection. We developed the "ColonClean" mobile health (mHealth) app for Android devices. It incorporates visual representations of dietary guidelines, steps for using bowel cleansing agents, and observations of the last bowel movement. We used the Technology Acceptance Model to investigate whether the use of the ColonClean mHealth app can improve users' attitudes and behaviors toward BP.

Objective

This study aims to validate the effectiveness of the ColonClean app in enhancing user behavior and improving BP, providing safe and cost-effective outpatient colonoscopy guidance.

Methods

This study uses a structured questionnaire to assess perceived usefulness, perceived ease of use, and users' attitudes and behaviors toward BP regarding the ColonClean mHealth app. A total of 40 outpatients who were physically and mentally healthy and proficient in Chinese were randomly chosen for this study. The data were analyzed using SPSS 25.0, and we used Pearson product-moment correlation and simple regression analysis to predict the perception of ColonClean.

Results

The results showed that 75% (30/40) of participants achieved an "excellent" or "good" level of BP according to the Aronchick Bowel Preparation Scale. Perceived usefulness and perceived ease of use of the ColonClean mHealth app were positively correlated with users' attitudes and behaviors (P<.05).

Conclusions

The ColonClean mHealth app serves as an educational reference and enhances the effectiveness of BP. Users expressed their willingness to use the app again in the future and recommend it to family and friends, highlighting its effectiveness as an educational guide for BP.

Development and Effectiveness Evaluation of 360-Degree Virtual Reality-Based Educational Intervention for Adult Patients Undergoing Colonoscopy

Providing patients with accurate and organized information about colonoscopy, while reducing anxiety, is critical to the procedure's success. This study evaluated the impact of an immersive 360° virtual reality (VR)-based educational intervention for first-time adult colonoscopy patients regarding anxiety, attitudes, knowledge, compliance with bowel preparation, and bowel cleanliness. A quasi-experimental design with a non-equivalent control group and non-synchronized pretest-post-test clinical trial was conducted with 40 patients in the experimental group and 40 in the control group. The 360° VR intervention included two sessions: precautions before colonoscopy and the colonoscopy process. The control group received education through individual verbal explanations with written materials. The findings indicated that the VR intervention significantly improved patients' colonoscopy-related anxiety, attitudes, adherence to bowel preparation instructions, and bowel cleanliness. Utilizing 360° VR as an educational tool has the potential to enhance the effectiveness of educational programs by providing realistic information and engaging patients. These findings suggest that 360° VR has the capacity to enhance screening rates and clinical outcomes by reducing negative perceptions associated with colonoscopy. Furthermore, the application of this method can extend to diverse diagnostic testing-related nursing situations in clinical settings.

A smartphone application to enhance bowel preparation for first-time colonoscopy: a randomized controlled study

BACKGROUND AND AIMS

Colonoscopy is an essential cancer screening tool; however, bowel preparation is a multifaceted process that involves several steps. Proper preparation is crucial for a successful colonoscopy in terms of diagnostic accuracy and procedural safety. We evaluated the performance of a smartphone application with bowel preparation instructions on individuals undergoing their first colonoscopy.

METHODS

In this randomized, prospective, endoscopist-blinded study, participants were scheduled to undergo their first colonoscopy between January 2020 and January 2022. The study protocol was registered at Thai Clinical Trials Registry (TCTR20190928002). They were randomly assigned to the smartphone education application (APP) or the standard education (control) group. The Boston Bowel Preparation Scale (BBPS) score, polyp detection rate (PDR), and adenoma detection rate (ADR) were compared. Factors associated with excellent bowel preparation were also evaluated.

RESULTS

In total, 119 patients (APP group, n = 57; control group, n = 62) underwent their first colonoscopy. The mean BBPS score and proportion of excellent bowel preparation (BBPS≥8) were significantly higher in the APP group than in the control group. Smartphone application-guided bowel preparation achieved a higher proportion of adequate and excellent bowel preparation scores, was associated with other quality indicators, and achieved the target ADR, cecal intubation rate, and adequate withdrawal time.

CONCLUSION

This application may be a user-friendly option to improve the first-time colonoscopy experience, resulting in effective screening of colorectal cancer.

CLINICAL TRIAL REGISTRATION

The study protocol was registered at Thai Clinical Trials Registry (TCTR20190928002).

Enhancing bowel preparation quality and tolerability in a low health literacy population in Western China: a multicenter randomized trial

BACKGROUND AND AIMS

Insufficient bowel preparation (BP) presents substantial challenges to the effectiveness of outpatient colonoscopy for colorectal cancer screening, particularly within populations characterized by low health literacy and poor adherence.

METHODS

We conducted a prospective, randomized, blinded, endoscopic controlled study involving 474 colonoscopy outpatients aged 18-80 years hailing from a low health literacy population with convenient access to WeChat. These patients were subsequently randomized into three groups: the control group, WeChat group, and the automatic reminder group (ARG). All people were administered 3 L of polyethylene glycol. The Boston Bowel Preparation Scale (BBPS) score of 6 or a segmental score of 2 was used as the primary outcome to evaluate BP quality. Secondary outcomes included polyp detection rate (PDR) and adverse events, etc. RESULTS: Our findings revealed that both the WeChat group (n = 158) and ARG (n = 158) exhibited significantly higher rates of adequate BP compared to the control group (n = 158) (WeChat vs. control, 79.1% vs. 61.4%; ARG vs. control, 74.7% vs. 61.4%; p < 0.001). Furthermore, these educationally reinforced groups displayed improved BP compliance (p < 0.05). According to the Hospital Anxiety and Depression Scale (HADS), patients in the reinforced education groups exhibited lower overall anxiety levels (p = 0.001) and experienced fewer adverse reactions (p = 0.019). Compared to the control group, the PDR in the right hemi-colon was significantly greater in the WeChat group (11.4%) (2.5%), and a similar trend was observed in the ARG (7.6%). Additionally, individuals in the WeChat group reported higher levels of satisfaction with their colonoscopy experience (p = 0.043). In a multivariate analysis, adjusting for potential confounding factors, WeChat-based re-education ([OR] 1.496, 95% CI 1.154-1.939; p = 0.002)) emerged as a protective factor for achieving adequate BP.

CONCLUSION

Enhanced education through WeChat can improve BP quality, and ARG applies equally to low health literacy populations.

Telephone instructions improve the quality of bowel preparation for colonoscopy: A meta-analysis of randomized controlled trials

OBJECTIVE

To evaluate the effect of telephone instructions on the quality of bowel preparation in patients undergoing colonoscopy.

METHODS

Online English databases (PubMed, Web of Science, Cochrane Library, and Embase) were screened for randomized controlled trials on telephone instructions regarding bowel preparation for colonoscopy from inception to April 15, 2022. After data extraction, the Review Manager software was used for meta-analysis.

RESULTS

Nine randomized controlled trials with 3,836 patients were included in the meta-analysis. The rate of adequate bowel preparation was significantly higher in the telephone group than in the control group. The pooled relative risk (RR) was 1.17 (95% confidence interval [CI]: 1.05-1.30, P < 0.01). The pooled mean difference (MD) for the Boston Bowel Preparation Scale score was 1.32 (95% CI: 0.15-2.49, P < 0.05), and that for the Ottawa Bowel Preparation Scale score was -1.93 (95% CI: -2.35 to -1.51, P < 0.01). The polyp detection rate was significantly higher in the telephone group than in the control group (RR = 1.58, 95% CI: 1.23-2.04, P < 0.01), whereas no significant difference was noted in the adenoma detection rate between the groups (RR = 1.37, 95% CI: 0.97-1.94, P = 0.08).

CONCLUSION

Telephone instructions for patients undergoing colonoscopy significantly improved the quality of bowel preparation and increased polyp detection rate.

Effect of Visual Booklets to Improve Bowel Preparation in Colonoscopy: Systematic Review with Meta-Analysis

An optimal bowel preparation for colonoscopy is essential to increasing the quality of the examination. Visual booklets have been proposed with conflicting results to enhance bowel preparation. A literature search was performed in March 2023 in the most important databases. Only RCTs were selected. We calculated odd ratios (OR) for dichotomous outcomes. Mean differences (MD) or standardized mean differences (SMD) were used for continuous outcomes. We estimated heterogeneity with the Chi² and the I² statistics. In cases of high heterogeneity, a random effect model was used. Six studies were selected, enrolling 1755 patients overall. Adequate bowel preparation was observed in 86.7% of the booklet group versus 77.5% of the control group, with an OR = 2.31 in favor of the booklet. In studies using a 4-L PEG-based preparation, no difference compared to controls was observed, while in non-PEG formulations, preparation with booklets was better than in controls (OR = 5.10, 95% CI 1.82-14.27, p = 0.002). Two studies were performed in an inpatient setting without any differences between booklets and controls, while outpatients receiving booklets had better results (OR = 7.13, 95% CI 5.39-9.45, p < 0.001). The adenoma detection rate was similar between the two groups. In conclusion, booklets are useful to improve bowel preparation. Outpatient settings and preparations not containing PEG could benefit more from booklets.

Improving bowel preparation for colonoscopy with a smartphone application driven by artificial intelligence

Optimal bowel preparation is a prerequisite for a successful colonoscopy; however, the rate of inadequate bowel preparation remains relatively high. In this study, we establish a smartphone app that assesses patient bowel preparation using an artificial intelligence (AI)-based prediction system trained on labeled photographs of feces in the toilet and evaluate its impact on bowel preparation quality in colonoscopy outpatients. We conduct a prospective, single-masked, multicenter randomized clinical trial, enrolling outpatients who own a smartphone and are scheduled for a colonoscopy. We screen 578 eligible patients and randomize 524 in a 1:1 ratio to the control or AI-driven app group for bowel preparation. The study endpoints are the percentage of patients with adequate bowel preparation and the total BBPS score, compliance with dietary restrictions and purgative instructions, polyp detection rate, and adenoma detection rate (secondary). The prediction system has an accuracy of 95.15%, a specificity of 97.25%, and an area under the curve of 0.98 in the test dataset. In the full analysis set (n = 500), adequate preparation is significantly higher in the AI-driven app group (88.54 vs. 65.59%; P < 0.001). The mean BBPS score is 6.74 ± 1.25 in the AI-driven app group and 5.97 ± 1.81 in the control group (P < 0.001). The rates of compliance with dietary restrictions (93.68 vs. 83.81%, P = 0.001) and purgative instructions (96.05 vs. 84.62%, P < 0.001) are significantly higher in the AI-driven app group, as is the rate of additional purgative intake (26.88 vs. 17.41%, P = 0.011). Thus, our AI-driven smartphone app significantly improves the quality of bowel preparation and patient compliance.

The Effectiveness of a Low-Cost Personalized Educational Program on the Quality of Bowel Cleansing Among Patients Undergoing a Colonoscopy

In relation to endoscopic practices, particularly a colonoscopy, patient education is required to maximize the quality of bowel preparation. Thus, the intention of this study is to examine how personalized patient education prior to a colonoscopy influences the quality of bowel preparation. A quasi-experimental post-test design was employed at the Kurdistan Center for Gastroenterology Hepatology and the Ebin Sina Center in Iraq from December 21, 2019, to September 30, 2020. Of 270 participants, 219 were selected for data analysis. The mean age ( SD ) of the participants was 41.18 (15.22), with a median of 41 years and a slightly higher percentage (58.4%) of females in comparison with males (41.6%). The bowel preparation quality of the control and intervention groups in the two centers was based on the Boston Bowel Preparation Scale scores and there was a significant difference ( p < .001) of M ± SD between the control (5.79 ± 1.123) and experimental (7.52 ± 1.225) groups. Findings suggest a personalized educational program is having a significant impact on increasing the quality of bowel preparation.

Pre-colonoscopy special guidance and education on intestinal cleaning and examination in older adult patients with constipation

BACKGROUND

The prevalence of constipation in the Chinese population over 60 years of age is 11.5%, and this prevalence increases with age, which seriously affects the quality of life in older adults. Therefore, reducing the incidence of constipation in older adults is necessary to promote a healthy lifestyle as well as biochemical health.

AIM

To explore the value of preoperative guidance and education to improve the effects of bowel cleaning in older adult patients undergoing colonoscopy.

METHODS

In this study, 160 older adult patients with constipation requiring colonoscopy at Shandong Provincial Hospital between January 2019 and March 2021 were selected and randomly divided into a study group and a control group, with 80 patients in each group. The study group received medication guidance and targeted educational guidance before the operation, while the control group received only medication and dietary guidance. The baseline data, colonoscopy duration, bowel preparation compliance, Boston bowel preparation (BBPS) assessment score, intestinal bubble score, the incidence of adverse reactions during bowel preparation, and nursing appointment satisfaction were compared between the two groups.

RESULTS

The colonoscopy duration times and intestinal bubble scores of the study group were shorter than those of the control group, with statistically significant differences. The BBPS scores for the right, left, and interrupted colon in the study group were also higher than those in the control group, and the difference was statistically significant. Additionally, the study group had a higher rate of liquid diet one day before the examination, higher rate of correct bowel-clearing agent dilution method, higher rate of accurate time of ingesting the bowel-clearing agent, and a higher proportion of patients ingesting bowel-clearing agent at the specified time than the control group, with statistically significant differences. The incidence of nausea and vomiting during bowel clearance in the study group was significantly lower than that in the control group. The incidence of abdominal pain, abdominal distension, dizziness, and fatigue was compared between the two groups, but the difference was not statistically significant. The scores of service attitude, detailed notification of dietary precautions, clear and easy-to-understand health educational content, and receiving care and comfort in the study group were significantly higher than those in the control group.

CONCLUSION

Preoperative special guidance and education were shown to significantly improve bowel clearance and compliance and reduce the incidence of adverse reactions in older adult patients with constipation undergoing colonoscopy. These factors are beneficial for improving patient satisfaction with nursing services.

The Impact of Patient Education Level on Split-Dose Colonoscopy Bowel Preparation for CRC Prevention

INTRODUCTION

AGA guidelines emphasize split-dose bowel preparation (BP) to ensure high-quality colonoscopy for the prevention of colorectal cancer (CRC). Split dose results in higher-quality preparation, but understanding instructions might be more difficult. Lower education levels may negatively influence BP quality. The confounding role of education level on BP quality was investigated.

METHODS

This was a cross-sectional study of 60 patients given split-dose BP. Patients consented and were asked three Likert scale questions based on BP instructions before the procedure. Compliance was self-reported. BP adequacy and the number of adenomas were recorded. BP was characterized as adequate (excellent, good) or inadequate (fair, poor). Data was analyzed with chi-square, odds ratio, Mann-Whitney, and regression analysis.

RESULTS

Thirty-one (52%) patients were high school graduates, 21 (38%) completed some college, and 6 (10%) were college graduates. College-educated patients had adequate BP (72%) more often than high school graduates (51%) (p = 0.02). Adenoma findings were not significantly different. The Likert scale mean ranks for patient understanding and reviewing of instructions were comparable between the two groups. Patient rating of scheduler explanations of the importance of following instructions was significantly better in the college group (mean ranks 2.59 and 1.83, respectively; p = 0.018).

DISCUSSION

Patient education level significantly affected the success of BP. Split BP can be more complex to comprehend, and instructions should consider patient education level. Specific intervention programs should be implemented to advise patients with less education that poor preparation may result in missed advanced neoplasias and subsequent procedures.

Alleviating Pregastroscopy Anxiety Using Mobile Social Media Application

Aim

The research aimed to study the effect of using WeChat (a mobile social media application) on pregastroscopy anxiety and the cooperation of patients with different coping styles.

Methods

In order to decrease patients' pregastroscopy anxiety and improve the tolerance of unsedated gastroscopy, WeChat, a widely used mobile social media application, was applied to provide information prior to their endoscopic procedure. Two hundred and thirty patients who underwent initial unsedated gastroscopy in a large teaching hospital in China were classified into two groups based on their coping style: information seekers or information avoiders, using the Information Subscale of the Krantz Health Opinion Survey (KHOS-I). Each of the two groups was prospectively randomly assigned to either receiving the brochure information or conjunctive interactive WeChat-delivered information of gastroscopy. To measure the level of state anxiety, the State Anxiety Scale of Spielberg's State-Trait Anxiety Inventory questionnaire was used. State anxiety, blood pressure and heart rate were measured at enrollment, upon arrival, and before gastroscopy.

Results

Information seekers and avoiders who received information from the brochure and the WeChat platform experienced significantly less state anxiety upon arrival and before gastroscopy. Furthermore, information seekers who received information from the conjunctive WeChat platform had lower frequency of retching, lower scores of nausea and bloating, and better tolerance. Information avoiders who received information from the conjunctive WeChat platform had lower frequency of retching, lower scores of discomfort while swallowing the scope and nausea, and better tolerance. However, we found the percentage of information seekers who preferred no WeChat-delivered pregastroscopy information is greater than WeChat-delivered information at the initial questionnaire. No significant difference was found in blood pressure or heart rate upon arrival and before gastroscopy.

Conclusions

Although people preferred no WeChat-delivered pregastroscopy information, the provision of gastroscopy information through a mobile social media application, such as WeChat, could significantly reduce patients' pregastroscopy anxiety, lower the frequency of retching, reduce the scores of nausea and bloating, and improve tolerance for information seekers. In addition, it could lower the frequency of retching, reduce the scores of discomfort while swallowing the scope and its concurrent nausea, and improve tolerance for information avoiders.

Reinforced education by short message service improves the quality of bowel preparation for colonoscopy

PURPOSE

This study aimed to evaluate the effect of reinforced education (RE) by short message service (SMS) on the bowel preparation quality of patients undergoing colonoscopy.

METHODS

Randomized controlled trials (RCTs), conducted on the effect of RE by SMS on bowel preparation for colonoscopy from inception to November 1, 2021, were queried from databases, including PubMed, Web of Science, the Cochrane Library, and EMBASE. After extracting the data, meta-analysis was conducted using Review Manager Software version 5.3.

RESULTS

A total of seven RCTs with 5889 patients were subjected to meta-analysis. The rate of adequate bowel preparation in the SMS group (81.7%) was significantly higher than that in the control group (75.7%) (RR: 1.10, 95% CI: 1.03-1.17, p < 0.01). Four studies suggested that RE by SMS significantly reduced the non-attendance rate of patients for scheduled colonoscopy (RR: 0.74, 95% CI: 0.56-0.99, p < 0.05).

CONCLUSION

RE by SMS for patients undergoing colonoscopy can significantly improve the quality of bowel preparation and decrease the non-attendance rate of patients for scheduled colonoscopy.

Colonoscopy: Preparation and Potential Complications

Colonoscopy is a fairly common test that serves both diagnostic and therapeutic purposes. It has been considered the gold standard in colorectal cancer screening for several years. Due to the nature of the examination, various types of complications may occur. The purpose of this analysis is to describe the various complications related to the period of preparation for colonoscopy among hospitalized patients, including life-threatening ones, in order to know how to avoid complications while preparing for a colonoscopy. We analyzed the nursing and medical reports of 9962 patients who were prepared for colonoscopy between 2005 and 2016. The frequency of various side effects associated with intensive bowel cleansing prior to colonoscopy was assessed. In justified cases, additional medical data were collected from patients, their families or from other doctors providing advice to patients after complications. Out of 9962 patients prepared for colonoscopy, 180 procedures were discontinued due to complications and side effects, and in these cases no colonoscopy was performed. The most common complications were: vomiting; epistaxis; loss of consciousness with head injury; abdominal pain; acute diarrhea; symptoms of choking; heart rhythm disturbances; dyspnea; fractures of limbs and hands; acute coronary syndrome; hypotension; hypertension; cerebral ischemia; severe blood glucose fluctuations; increased muscle contraction and allergic reactions. In addition to the documentation of our own research, several works of other research groups were also analyzed. Currently, the literature does not provide data on the frequency and type of complications in the preparation period for colonoscopy. The advantage of our work is the awareness of the possibility of serious complications and postulating the necessary identification of threats. Individualization of the recommended procedures and increased supervision of patients undergoing bowel cleansing procedure, we hope, will reduce the occurrence of complications and side effects.

State-of-the-Art Review on Immersive Virtual Reality Interventions for Colonoscopy-Induced Anxiety and Pain

BACKGROUND

Colonoscopy related fear impairs the current gold standard screening of colorectal cancer. Compared to other minimally invasive procedures for cancer screening, colonoscopy-induced anxiety exceeds the procedure through bowel preparation. Immersive virtual reality's (iVR) role in alleviating the complex stress-pain relationship encountered during medical procedures is directly proportional to the rising affordability of state-of-the-art Head-Mounted-Displays (HMDs).

OBJECTIVE

to assess the effect of iVR on patients' colonoscopy-induced anxiety and pain.

MATERIALS AND METHODS

A systematic search was conducted in PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Embase and Scopus databases up to January 2022. Clinical trials evaluating anxiety as an outcome were included without language restriction.

RESULTS

Four clinical trials were included: three on the patients' intraprocedural anxiety and one on patient education. Intraprocedural iVR interventions for colonoscopy-induced anxiety and pain revealed a similar effect as conventional sedation, while a statistically significant reduction was reported for non-sedated patients. iVR patient education improved the quality of bowel preparation and reduced patient anxiety before colonoscopy.

CONCLUSIONS

The current research highlights the need to use high-end HMDs and appropriate interactive iVR software content for colonoscopy-induced anxiety. Methodological frameworks regarding the eligibility of participants, double-blinding and randomization of iVR studies can facilitate the development of iVR implementation for anxiety and pain management.

Effect of WeChat Messaging on Improving the Quality of Bowel Preparation for Outpatient Colonoscopy: A Randomized Controlled Study

With the most active users of any social media platform in China, WeChat has become the preferred platform for public announcements and is widely used in the fields of medicine and nursing (Hong, Zhou, Fang, & Shi, 2017; Zeng, Deng, Wang, & Liu, 2016). The aim of this study was to evaluate the effect of WeChat messaging on bowel preparation for outpatient colonoscopy. A total of 150 outpatients scheduled for colonoscopy in a Grade III level A hospital were randomly assigned to the experimental group (n = 73) or the control group (n = 72). Both groups received routine guidance from the day of the scheduling appointment through the day of colonoscopy. In addition, the experimental group received colonoscopy-related information and individualized guidance daily through WeChat from the day of the appointment. After the colonoscopy, the diet and medication compliance, satisfaction, anxiety, and bowel cleanliness were compared. Post-intervention, there were significant differences in bowel cleanliness, satisfaction, diet and medication compliance, and anxiety between the two groups. WeChat messaging can help improve diet and medication compliance, patient satisfaction, and the success rate and thoroughness of colonoscopy, as well as alleviate the anxiety of patients scheduled for outpatient colonoscopy.

Impact of Patient Education via WeChat on Bowel Preparation for Colonoscopy: A Meta-analysis of Randomized Controlled Trials

The aim of this study was to evaluate the impact of education via WeChat on the quality of bowel preparation in patients undergoing colonoscopy through a meta-analysis of randomized controlled trials. Randomized controlled trials of bowel preparation education provided via WeChat for patients undergoing colonoscopy were screened from databases such as PubMed, Web of Science, Cochrane Library, and Embase. Papers published from the date of database construction to May 1, 2021, were extracted, and a meta-analysis was performed using Review Manager software. A total of four randomized controlled trials were included in the meta-analysis. The results showed that for patients undergoing colonoscopy, education via WeChat significantly improves the quality of bowel preparation for colonoscopy, reduces the insertion time, and increases the adenoma detection rate and the patient's compliance and willingness to repeat bowel preparation. In conclusion, education via WeChat before colonoscopy can significantly improve the quality of bowel preparation.

Relationship between Health Literacy and Knowledge, Compliance with Bowel Preparation, and Bowel Cleanliness in Older Patients Undergoing Colonoscopy

Compared to young adults, it is difficult for the older people with relatively low health literacy to perform proper bowel preparation for a colonoscopy. This study aims to identify the relationship between knowledge, compliance with bowel preparation, and bowel cleanliness with health literacy in older patients undergoing colonoscopy. The participants were 110 older people undergoing colonoscopy, recruited from an endoscopy hospital in G metropolitan city, South Korea. Data obtained from a structured questionnaire that included items on health literacy and knowledge of and compliance with bowel preparation, and the Aronchick bowel cleanliness scale. The data were analyzed using descriptive statistics, χ-test, Pearson's correlation, t-test, and ANCOVA. Participants who were younger and those with a higher education level and better economic status had a statistically significantly higher health literacy level. Older people with a health literacy level of 7 points and above had a higher knowledge level and bowel cleanliness index, a showed better compliance with bowel preparation. The results highlight the need for developing a customized education intervention program that can improve health literacy for successful bowel preparation and examination of the older population undergoing colonoscopy.

Combination of Enhanced Instructions Improve Quality of Bowel Preparation: A Prospective, Colonoscopist-Blinded, Randomized, Controlled Study

BACKGROUND

Appropriate bowel preparation is highly important for the efficacy of colonoscopy; however, up to one-third of patients do not accomplish adequate bowel preparation.

OBJECTIVE

We investigated the impact of the combination of enhanced instruction on the quality of bowel preparation and its impact on clinically relevant outcomes.

DESIGN

This was a colonoscopist-blinded, prospective, randomized trial.

SETTINGS

All patients received regular instructions for bowel preparation. Patients were randomly assigned to the control, telephone reeducation, and combined enhanced instruction groups.

PATIENTS

Outpatients aged 19 to 75 years scheduled to undergo colonoscopy were included.

MAIN OUTCOME MEASURES

The main outcome was adequate bowel preparation rate.

RESULTS

A total of 311 patients were randomly assigned to the combined enhanced instruction (n = 104), telephone reeducation (n = 101), and control groups (n = 106). An intention-to-treat analysis showed that the adequate bowel preparation rate was higher in the combined enhanced instruction group than in the telephone reeducation and control groups (92.3% vs 82.2% vs 76.4%, p = 0.007). The rate of compliance with the instructions was significantly higher in the combined enhanced instruction group than in the telephone reeducation and control groups. Method of education was associated with proper bowel preparation (adjusted OR 17.46; p < 0.001 for combined enhanced instruction relative to control).

LIMITATIONS

This was a single-center study conducted in Korea.

CONCLUSIONS

Combined enhanced instruction as an adjunct to regular instructions much improved the quality of bowel preparation and patients' adherence to the preparation instructions. The combined enhanced instruction method could be the best option for bowel preparation instruction. See Video Abstract at http://links.lww.com/DCR/B673.

LA COMBINACIN DE INSTRUCCIONES MEJORADAS, INCREMENTA LA CALIDAD DE LA PREPARACIN INTESTINAL ESTUDIO PROSPECTIVO, CONTROLADO, ALEATORIO Y CIEGO PARA EL COLONOSCOPISTA

ANTECEDENTES:La preparación adecuada del intestino es muy importante para la eficacia de la colonoscopia; sin embargo, hasta un tercio de los pacientes no logran buenos resutlados.OBJETIVO:Investigar el impacto de la combinación de instrucciónes claras en la calidad de la preparación intestinal y su impacto en los resultados clínicos.DISEÑO:Trabajo aleatorio, prospectivo y ciego para el colonoscopista.AJUSTES:Los pacientes recibieron instrucciones periódicas para la preparación intestinal. Fueron asignados aleatoriamente al grupo control, educación telefónica y de instrucción mejoradas.PACIENTES:Se incluyeron pacientes ambulatorios de 19 a 75 años programados para ser sometidos a colonoscopia.PRINCIPALES MEDIDAS DE RESULTADO:El principal resultado fue una adecuada preparación intestinal.RESULTADOS:Un total de 311 pacientes fueron asignados al azar a la instrucción mejorada combinada (n = 104), reeducación telefónica (n = 101) y grupo de control (n = 106). El análisis estadístico mostró que la tasa de preparación intestinal adecuada fue mayor en el grupo combinado de instrucción mejorada que en los grupos de reeducación telefónica y control (92,3% vs 82,2% vs 76,4%, p = 0,007). La tasa de cumplimiento de las instrucciones fue significativamente mayor en el grupo de instrucción mejorada combinada que en los otros. El método de educación se asoció con una preparación intestinal adecuada (razón de posibilidades ajustada de 17,46; p <0,001 para la instrucción mejorada combinada en relación con el control.LIMITACIONES:Estudio en un solo centro realizado en Corea.CONCLUSIONES:La instrucción mejorada combinada como complemento de las instrucciones regulares mejoró mucho la calidad de la preparación intestinal y la adherencia de los pacientes a las instrucciones de preparación. El método de instrucción mejorado combinado podría ser la mejor opción para la instrucción de preparación intestinal. Consulte Video Resumen en http://links.lww.com/DCR/B673.

Efficacy of ultra-low volume (≤1 L) bowel preparation fluids: Systematic review and meta-analysis

BACKGROUND AND AIMS

High-quality bowel preparation is paramount for the diagnostic accuracy and safety of colonoscopy; however, it is often difficult for patients to adhere to high-volume laxatives, which may contribute to poor bowel preparation. This review aims to assess the efficacy of bowel preparation fluids of 1 L or less (≤1 L).

METHODS

We performed a systematic review including all relevant randomized controlled trials on ultra-low volume (≤1 L) bowel preparation fluids for colonoscopy published since 2015. Primary endpoint was the percentage of adequately prepared patients. Secondary endpoints included adenoma detection rate (ADR) and safety.

RESULTS

Bowel preparation with sodium picosulfate/magnesium citrate (SPMC; 19 trials, n = 10,287), 1L-polyethylene glycol with ascorbate (PEGA; 10 trials, n = 1717), sodium phosphate (NaP; 2 trials, n = 621), and oral sulfate solution (OSS; 3 trials, n = 597) was adequate in 75.2%, 82.9%, 81.9%, and 92.1%, respectively, of patients; however, heterogeneity between studies was considerable (I² range: 86-98%). Pooled ADRs were 31.1% with SPMC, 32.3% with 1L-PEGA, 30.4% with NaP, and 40.9% with OSS. Temporary electrolyte changes were seen with all ultra-low volume bowel preparation fluid solutions but without sustained effects in most patients.

CONCLUSION

Ultra-low volume bowel preparation fluids do not always meet the 90% quality standard for adequate bowel preparation as defined by current guidelines. Nonetheless, they may be considered in patients intolerant for higher-volume laxatives and without risk factors for inadequate bowel preparation or dehydration-related complications.

Patients' Experiences Before, During, and After a Colonoscopy Procedure: A Qualitative Study

Although colonoscopy is a common examination, there is limited research focusing on how patients experience this procedure. It is important that a colonoscopy is tolerated, as it may lead to lifesaving diagnostics and treatment. This study aims to explore adult patients' experience of undergoing a colonoscopy regarding the time prior to, during, and after the procedure. This was a qualitative study with individual interviews (n = 24) and a purposeful sample that was analyzed using thematic analysis. The analysis revealed four themes. The first, "making up one's mind," describes how the participants gathered information and reflected emotionally about the forthcoming procedure. The hope of clarification motivated them to proceed. In the theme "getting ready," self-care was in focus while the participants struggled to follow the instructions and carry out the burdensome cleansing. The next theme, "going through," illuminates' experiences during the colonoscopy and highlights the importance of feeling involved and respected. The last theme, "finally over," is characterized by experiences of relief, tiredness, and a desire for clarity. The healthcare professionals' ability to meet the participants' needs is vital, given that the experiences are highly individual. These findings contribute to a variegated image of how patients experience the process of undergoing a colonoscopy.

Educating Outpatients for Bowel Preparation Before Colonoscopy Using Conventional Methods vs Virtual Reality Videos Plus Conventional Methods: A Randomized Clinical Trial

IMPORTANCE

Adequate bowel preparation is essential for diagnostic, screening, and surveillance colonoscopy. Virtual reality (VR) has the characteristics of immersion, interaction, and imagination and has been widely used in medicine for training and teaching, indicating that it could be used in the education of outpatients for bowel preparation before colonoscopy.

OBJECTIVE

To investigate whether using VR videos for patient education before colonoscopy could improve bowel preparation.

DESIGN, SETTING, AND PARTICIPANTS

A prospective, single-blinded, randomized clinical trial of 346 patients undergoing colonoscopy with local anesthesia in a tertiary care hospital was conducted between October 1, 2018, and November 1, 2020. Outpatients who had indications for colonoscopy and had not received one before were enrolled. Statistical analysis was performed from November 1 to December 31, 2020. All data were analyzed according to the intention-to-treat approach.

EXPOSURES

Conventional bowel preparation education (oral instructions and written materials that had the same contents) or conventional education plus VR videos.

MAIN OUTCOMES AND MEASURES

The primary outcome was the quality of bowel preparation measured by the Boston Bowel Preparation Scale score (range, 0-9, where 0 indicates extremely unsatisfactory bowel preparation and 9 indicates complete bowel preparation). Secondary outcomes included polyp and adenoma detection rates, compliance with complete bowel cleansing, preprocedure anxiety, overall satisfaction, and willingness to undergo a follow-up colonoscopy.

RESULTS

A total of 346 outpatients were enrolled in the trial, with 173 patients randomly assigned to each group (control group: 87 women [50.3%]; mean [SD] age, 50.5 [12.5] years; VR video group: 84 women [48.6%]; mean [SD] age, 52.6 [11.4] years). Baseline characteristics, including demographic information, medical history, lifestyle, and the characteristics of stool, were comparable between the VR video group and the control group. The mean (SD) Boston Bowel Preparation Scale score was significantly higher in the VR video group than in the control group (7.61 [1.65] vs 7.04 [1.70]; P = .002). The detection rate of polyps (72 of 172 [41.9%] vs 46 of 172 [26.7%]; P = .003) and the detection rate of adenomas (56 of 172 [32.6%] vs 38 of 172 [22.1%]; P = .03) were also higher in the VR video group. Patients who received VR education had better compliance (119 [68.8%] vs 87 [50.3%]; P < .001) and higher mean (SD) overall satisfaction (8.68 [1.70] vs 8.16 [2.15]; P = .01) with bowel preparation.

CONCLUSIONS AND RELEVANCE

Patients who received VR video education before colonoscopy had better bowel preparation, higher polyp and adenoma detection rates, and improved compliance and satisfaction.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03667911.

Effects of a Personalized Smartphone App on Bowel Preparation Quality: Randomized Controlled Trial

Background

Adequate bowel preparation is essential for the visualization of the colonic mucosa during colonoscopy. However, the rate of inadequate bowel preparation is still high, ranging from 18% to 35%; this may lead to a higher risk of missing clinically relevant lesions, procedural difficulties, prolonged procedural time, an increased number of interval colorectal carcinomas, and additional health care costs.

Objective

The aims of this study are to compare bowel preparation instructions provided via a personalized smartphone app (Prepit, Ferring B V) with regular written instructions for bowel preparation to improve bowel preparation quality and to evaluate patient satisfaction with the bowel preparation procedure.

Methods

Eligible patients scheduled for an outpatient colonoscopy were randomized to a smartphone app group or a control group. Both the groups received identical face-to-face education from a research physician, including instructions about the colonoscopy procedure, diet restrictions, and laxative intake. In addition, the control group received written information, whereas the smartphone app group was instructed to use the smartphone app instead of the written information for the actual steps of the bowel preparation schedule. All patients used bisacodyl and sodium picosulfate with magnesium citrate as laxatives. The quality of bowel preparation was scored using the Boston Bowel Preparation Scale (BBPS) by blinded endoscopists. Patient satisfaction was measured using the Patient Satisfaction Questionnaire-18.

Results

A total of 87 patients were included in the smartphone app group and 86 in the control group. The mean total BBPS score was significantly higher in the smartphone app group (mean 8.3, SD 0.9) than in the control group (mean 7.9, SD 1.2; P=.03). The right colon showed a significantly higher bowel preparation score in the smartphone app group (mean 2.7, SD 0.5 vs mean 2.5, SD 0.6; P=.04). No significant differences were observed in segment scores for the mean transverse colon (mean 2.8, SD 0.4 vs mean 2.8, SD 0.4; P=.34) and left colon (mean 2.8, SD 0.4 vs mean 2.6, SD 0.5; P=.07). General patient satisfaction was high for the smartphone app group (mean 4.4, SD 0.7) but showed no significant difference when compared with the control group (mean 4.3, SD 0.8; P=.32).

Conclusions

Our personalized smartphone app significantly improved bowel preparation quality compared with regular written instructions for bowel preparation. In particular, in the right colon, the BBPS score improved, which is of clinical relevance because the right colon is considered more difficult to clean and the polyp detection rate in the right colon improves with improvement of bowel cleansing of the right colon. No further improvement in patient satisfaction was observed compared with patients receiving regular written instructions.

Trial Registration

ClinicalTrials.gov NCT03677050; https://clinicaltrials.gov/ct2/show/NCT03677050

Mobile health technologies supporting colonoscopy preparation: A systematic review and meta-analysis of randomized controlled trials

Background

Mobile health (mHealth) technologies are innovative solutions for delivering instructions to patients preparing for colonoscopy.

Objective

To systematically review the literature evaluating the effectiveness of mHealth technologies supporting colonoscopy preparation on patient and clinical outcomes.

Methods

MEDLINE, EMBASE, CINAHL and CENTRAL were searched for randomized controlled trials (RCTs) that evaluated the effectiveness of mHealth technologies for colonoscopy preparation on patient and clinical outcomes. Two reviewers independently assessed study eligibility, extracted data, and appraised methodological quality using the Cochrane Risk-of-Bias tool. Data were pooled using random effects models and when heterogeneity, assessed using I², was statistically significant, a qualitative synthesis of the data was performed. Publication bias was assessed using a funnel plot.

Results

Ten RCTs (3,383 participants) met inclusion criteria. MHealth interventions included smartphone apps, SMS text messages, videos, camera apps, and a social media app. Outcomes were bowel cleanliness quality, user satisfaction, colonoscopy quality indicators (cecal intubation time, withdrawal time, adenoma detection rate), adherence to diet, and cancellation/no-show rates. MHealth interventions were associated with better bowel cleanliness scores on the Boston Bowel Preparation Scale [standardized mean difference (SMD) 0.57, 95%CI 0.37–0.77, I² = 60%, p = 0.08] and the Ottawa Bowel Preparation Scale [SMD -0.39, 95%CI -0.59–0.19, I² = 45%, p = 0.16], but they were not associated with rates of willingness to repeat the colonoscopy using the same regimen [odds ratio (OR) 1.88, 95%CI 0.85–4.15, I² = 48%, p = 0.12] or cancellations/no-shows [OR 0.96, 95%CI 0.68–1.35, I² = 0%]. Most studies showed that adequate bowel preparation, user satisfaction and adherence to diet were better in the intervention groups compared to the control groups, while inconsistent findings were observed for the colonoscopy quality indicators. All trials were at high risk of bias for lack of participant blinding. Visual inspection of a funnel plot revealed publication bias.

Conclusions

MHealth technologies show promise as a way to improve bowel cleanliness, but trials to date were of low methodological quality. High-quality research is required to understand the effectiveness of mHealth technologies on colonoscopy outcomes.

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

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 3 D animations. We hypothesized that CBE could replace nurse counselling without loss of bowel preparation quality 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 for outpatient clinic visits; patient anxiety/satisfaction scores; and information recall. 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 the per-protocol analysis, 217 in the nurse counselling and 280 in the CBE group. Baseline characteristics were similarly distributed among the groups. On per-protocol analysis, adequate bowel cleansing was achieved in 93.2 % (261/280) of CBE patients, which was non-inferior to nurse-counselled patients (94.0 %; 204/217), with a difference of -0.8 % (95 % confidence interval [CI] -5.1 % to 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, with 3.0 % needing an extra outpatient visit.

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 to inform patients before colonoscopy in routine clinical practice.

Experiences of Patients Undergoing Bowel Preparation and Colonoscopy: A Qualitative Longitudinal Study

Introduction

Colonoscopy remains the reference standard for diagnosing and monitoring colorectal cancer and for diagnosis and surveillance of inflammatory bowel disease. However, there is a limited knowledge of the patients’ needs when undergoing colonoscopy and the challenges within in order to reduce the number of cancelled colonoscopies. The purpose of the study was to explore the experiences of undergoing bowel preparation and colonoscopy.

Methods

The study was designed as a qualitative longitudinal interview study with an inductive research approach. Patients were considered for inclusion consecutively and selected based on the following criteria of variation: way of referral for colonoscopy (outpatient or screening), age and gender. The interviews were analyzed using qualitative content analysis, and results reported according to COREQ guidelines.

Results

Based on the findings, three categories emerged: To weigh up participation, A greater challenge than expected, and Not so challenging after all. Throughout these categories, the experience of uncertainty was reported.

Discussion

The process of undergoing bowel preparation and colonoscopy was influenced by uncertainty due to insufficient information. There is a need to strengthen the patient-centered care by adjusting the information to patient’s needs to better support them in decision-making for participation, to better prepare them for the bowel preparation and to better prepare them for the procedure. In addition, it is vital that patients are provided with results of the colonoscopy that correspond to the timeframe specified in written information.

Integrated Digital Patient Education at the Bedside for Patients with Chronic Conditions: Observational Study

BACKGROUND

Patient education delivered by a health care provider increases patients' understanding and adherence to medical instructions, which helps to improve patient health. Multiple challenges exist to delivering effective patient education to patients with multiple chronic conditions, including giving the necessary time, range, and types of learning materials, and assessing the level of understanding. To help overcome these challenges, it is important to study new electronic means to assist in patient education, such as the use of mobile devices, interactive media, 3-dimensional images, and multimedia educational content at the bedside.

OBJECTIVE

The goal of this study was to address the need for blended learning strategies combining technical and workflow integration of digital patient education systems for patients with chronic conditions within and across the regular process of care. Studies are needed to evaluate the utility and benefits of these technologies for providers and patients alike.

METHODS

A mixed-methods approach was employed including survey administration to 178 patients after they received digital patient education in person with a health care provider, and qualitative interviews with 16 nurse educators who used the mobile digital health education technology to deliver instruction to patients. Patient survey data were analyzed using chi-square statistical tests. Qualitative interviews were analyzed for user acceptance and perceived value themes.

RESULTS

Patients who were counseled using a blended digital health education approach reported improved understanding of educational content (P=.034) and chronic health conditions (P<.001), were more motivated to care for themselves at home (P<.001), were more likely to say that they felt capable of making health care decisions with their doctors (P<.001) and on their own (P=.001), and were more likely to report their intention to follow their doctor's instructions (P<.001) than were patients whose education was not computer-based. Nurse educators felt that the digital education system and content enhanced their education efforts and could be easily integrated into the outpatient clinical workflow.

CONCLUSIONS

Patient education for individuals with chronic conditions may be more effective than traditional formats when provided in blended digital formats supervised by a health care provider.

Perceptions of patients undergoing percutaneous coronary intervention on pre-operative education in China: A qualitative study

Objectives

To explore the perceptions of patients undergoing percutaneous coronary intervention (PCI) regarding their pre‐operative health education.

Methods

A qualitative study using semi‐structured, in‐depth interviews was conducted in one cardiology unit in China from July 2019 to December 2019. Purposeful sampling of 17 patients undergoing PCI was interviewed about their perceptions of pre‐operative health education. Thematic analysis of the transcribed data was then used to identify the themes.

Results

Four themes emerged from the data:(a) triple roles of pre‐operative education with the categories of relief (reliving fear); burden (leading to stress); and meaningless (changing nothing); (b) family member involvement with the categories of shared responsibility and family members’ duty; (c) facilitators in the process of pre‐operative health education with the categories of emotional support, plain language and individualized pre‐operative education; (d) inhibitors in the process of pre‐operative health education with the categories of contradiction and threatening words.

Conclusions

Pre‐operative health education for patients undergoing PCI should be aligned with the individual patients’ information‐seeking styles and personal differences, emphasizing individualized patient education. Traditional Chinese philosophy should be considered in the practice of pre‐operative education for patients undergoing PCI, which emphasizes family member involvement; at the same time, patient empowerment and self‐care should also be stressed. In addition, emotional support and plain language from health professionals are important in pre‐operative health education for patients undergoing PCI; contradiction should be avoided, and threatening words should be used with caution and with consideration for cultural variations during pre‐operative education for patients undergoing PCI.

New Patient Education Video on Colonoscopy Preparation: Development and Evaluation Study

BACKGROUND

Although several patient education materials on colonoscopy preparation exist, few studies have evaluated or compared them; hence, there is no professional consensus on recommended content or media to use.

OBJECTIVE

This study aims to address this need by developing and evaluating a new video on colonoscopy preparation.

METHODS

We developed a new video explaining split-dose bowel preparation for colonoscopy. Of similar content videos on the internet (n=20), the most favorably reviewed video among patient and physician advisers was used as the comparator for the study. A total of 232 individuals attending gastroenterology or urology clinics reviewed the new and comparator videos. The order of administration of the new and comparator videos was randomly counterbalanced to assess the impact of presentation order. Respondents rated each video on the following dimensions: information amount, clarity, trustworthiness, understandability, new or familiar information, reassurance, information learned, understanding from the patient's point of view, appeal, and the likelihood of recommending the video to others.

RESULTS

Overall, 71.6% (166/232) of the participants preferred the new video, 25.0% (58/232) preferred the comparator video, and 3.4% (8/232) were not sure. Furthermore, 64.0% (71/111) of those who viewed the new video first preferred it, whereas 77.7% (94/121) of the participants who viewed the new video second preferred it. Multivariable logistic regression analysis also demonstrated that participants were more likely to prefer the new video if they had viewed it second. Participants who preferred the new video rated it as clearer and more trustworthy than those who preferred the comparator video.

CONCLUSIONS

This study developed and assessed the strengths of a newly developed colonoscopy educational video.

Ward nurses-focused educational intervention improves the quality of bowel preparation in inpatients undergoing colonoscopy: A CONSORT-compliant randomized controlled trial

BACKGROUND

Adequate bowel preparation is essential for the detection of pathological lesions during colonoscopy. However, it has been found to be inadequate in approximately 20% to 30% of colonoscopy examinations. Educational interventions focused on health staff, such as physicians and nurses, may improve the patients' understanding of the bowel preparation instructions, and consequently, increase the quality of bowel preparation.

OBJECTIVES

To investigate whether enhanced education of ward nurses could improve the bowel preparation quality in inpatients undergoing colonoscopy.

DESIGN

This was a single-center randomized controlled study.

METHODS

A total of 190 consecutive inpatients scheduled to undergo colonoscopy from March 2019 to March 2020 were randomized to the educated (nurses with enhanced education) or control group (nurses without enhanced education). We assessed the bowel preparation quality using the Boston bowel preparation scale.

RESULTS

There were 89 patients in the educated group and 101 patients in the control group. The proportion of colonoscopies with adequate bowel preparation was 83.1% in the educated group and 69.3% in the control group. Patients' compliance with bowel preparation in the educated group was superior to that in the control group. Furthermore, significantly better sleep quality was found in the educated group. The multivariate logistic regression analysis identified the ward nurses-focused enhanced educational intervention as a risk factor for bowel preparation quality.

CONCLUSIONS

The ward nurses-focused educational intervention improved the bowel preparation quality and reduced the adverse event rates in inpatients undergoing colonoscopy.

TRIAL REGISTRATION

This study was registered in the Chinese Clinical Trial Registry under number ChiCTR2000030366.

Impact of mobile health and medical applications on clinical practice in gastroenterology

Mobile health apps (MHAs) and medical apps (MAs) are becoming increasingly popular as digital interventions in a wide range of health-related applications in almost all sectors of healthcare. The surge in demand for digital medical solutions has been accelerated by the need for new diagnostic and therapeutic methods in the current coronavirus disease 2019 pandemic. This also applies to clinical practice in gastroenterology, which has, in many respects, undergone a recent digital transformation with numerous consequences that will impact patients and health care professionals in the near future. MHAs and MAs are considered to have great potential, especially for chronic diseases, as they can support the self-management of patients in many ways. Despite the great potential associated with the application of MHAs and MAs in gastroenterology and health care in general, there are numerous challenges to be met in the future, including both the ethical and legal aspects of applying this technology. The aim of this article is to provide an overview of the current status of MHA and MA use in the field of gastroenterology, describe the future perspectives in this field and point out some of the challenges that need to be addressed.

Effect of Short Message Service Use on Bowel Preparation Quality in Patients Undergoing Colonoscopy

This study aimed to determine the effect of SMS use on the bowel preparation quality and satisfaction in patients who underwent colonoscopy. This study was conducted as an experimental-control study with 200 patients who had received colonoscopy in the endoscopy unit of a university hospital in Eastern Thrace of Turkey between December 1, 2016, and June 30, 2017. All patients received a standard bowel preparation. The SMS was sent in addition to the standard bowel preparation to patients in an SMS group. In the SMS group, patients were informed about the standard bowel preparation practices via SMS 3 days before colonoscopy. "Patient identification," "bowel preparation quality," and "patient satisfaction" forms were used for data collection. Chi-square and independent sample t tests were used in data analysis. The average age of the participants was 57.57 ± 12.37 years, and it was determined that most of the participants were male (64.5%) and had colonoscopy experience (55%). The bowel preparation quality was significantly higher in the SMS group than in the no-SMS group (p = .044), and most patients (91%) were "very satisfied" with being informed via SMS. Sending SMS about bowel preparation practices to colonoscopy patients improves bowel preparation quality and patient satisfaction. Integrating SMS into standard care may help patients manage the bowel preparation process.

Cloud-based multi-media systems for patient education and adherence: a pilot study to explore patient compliance with colonoscopy procedure preparation

Technology based patient education and adherence approaches are increasingly utilized to instruct and remind patients to prepare correctly for medical procedures. This study examines the interaction between two primary factors: patterns of patient adherence to challenging medical preparation procedures; and the demonstrated, measurable potential for cloud-based multi-media information technology (IT) interventions to improve patient adherence. An IT artifact was developed through prior design science research to serve information, reminders, and online video instruction modules to patients. The application was tested with 297 patients who were assessed clinically by physicians. Results indicate modest potential (43.4% relative improvement) for the IT-based approach for improving patient adherence to endoscopy preparations. Purposively designed cloud-based applications hold promise for aiding patients with complex medical procedure preparation. Health care provider involvement in the design and evaluation of a patient application may be an effective strategy to produce medical evidence and encourage the adoption of adherence apps.

What Patients Want in a Smartphone App That Supports Colonoscopy Preparation: Qualitative Study to Inform a User-Centered Smartphone App

Background

The preparation for colonoscopy is elaborate and complex. In the context of colorectal cancer screening, up to 11% of patients do not keep their colonoscopy appointments and up to 33% of those attending their appointments have inadequately cleansed bowels that can delay cancer diagnosis and treatment. A smartphone app may be an acceptable and wide-reaching tool to improve patient adherence to colonoscopy.

Objective

The aim of this qualitative study was to employ a user-centered approach to design the content and features of a smartphone app called colonAPPscopy to support individuals preparing for their colonoscopy appointments.

Methods

We conducted 2 focus group discussions (FGDs) with gastroenterology patients treated at the McGill University Health Centre in Montreal, Canada. Patients were aged 50 to 75 years, were English- or French-speaking, and had undergone outpatient colonoscopy in the previous 3 months; they did not have inflammatory bowel disease or colorectal cancer. FGDs were 75 to 90 min, conducted by a trained facilitator, and audiotaped. Participants discussed the electronic health support tools they might use to help them prepare for the colonoscopy, the content needed for colonoscopy preparation, and the features that would make the smartphone app useful. Recordings of FGDs were transcribed and analyzed using thematic analysis to identify key user-defined content and features to inform the design of colonAPPscopy.

Results

A total of 9 patients (7 male and 2 female) participated in one of 2 FGDs. Main content areas focused on bowel preparation instructions, medication restrictions, appointment logistics, communication, and postcolonoscopy expectations. Design features to make the app useful and engaging included minimization of data input, reminders and alerts for up to 7 days precolonoscopy, and visual aids. Participants wanted a smartphone app that comes from a trusted source, sends timely and tailored messages, provides reassurance, provides clear instructions, and is simple to use.

Conclusions

Participants identified the need for postcolonoscopy information as well as reminders and alerts in the week before colonoscopy, novel content, and features that had not been included in previous smartphone-based strategies for colonoscopy preparation. The ability to tailor instructions made the smartphone app preferable to other modes of delivery. Study findings recognize the importance of including potential users in the development phase of building a smartphone app.

A short telephone-call reminder improves bowel preparation, quality indicators and patient satisfaction with first colonoscopy

BACKGROUND AND STUDY AIMS

 Addition of a reminder program to conventional indications improves colonoscopy. The aim of this study was to evaluate the effectiveness of a short telephone call reminder (STCR) on a patient's first colonoscopy.

PATIENTS AND METHODS

 One day before colonoscopy, we made a STCR of < 10 minutes to 141 randomly selected patients of 258 recruited. The STCRs informed patients about the procedure date, indications for taking laxatives, and dietetic requirements. Questions were clarified only when patients asked directly. We evaluated bowel preparation, quality indicators, and patient satisfaction. Data were expressed as mean ± SD and percentages. Statistical differences were evaluated by Student's t and Chi squared tests; alpha = 0.05. All authors had access to the study data and reviewed and approved the final manuscript.

RESULTS

 The STCR group had better bowel preparation which was demonstrated by higher completion frequency (97.16 % vs. 82.05 %), in less time (4.52 ± 3.06 vs. 5.38 ± 3.03 hours) intake of laxative, and higher Boston's scale (7.66 ± 2.42 vs. 5.2 ± 1.65). Quality indicators of colonoscopy were better in patients that received a STCR [cecal intubation rate: 100.00 % vs. 87.18 %; polyp detection: 42.55 % vs. 9.4 %; and cecal arrival time (min): 12.09 ± 3.62 vs. 15.09 ± 5.02]. STCR patients were more satisfied (97.87 % vs. 55.56 %) and would repeat colonoscopy (21.99 % vs. 11.11 %).

CONCLUSIONS

 A simple additional step such as a STCR improves quality of bowel preparation, quality indicators, and satisfaction of patients undergoing their first colonoscopy. Clinical trial registry in Mexico City General Hospital: DI/16/107/3/108.