Impact of reinforced education by telephone and short message service on the quality of bowel preparation: a randomized controlled study

Background and study aims: High quality bowel preparation is essential for successful colonoscopy. This study aimed to assess the impact of reinforced education by telephone or short message service (SMS) on the quality of bowel preparation.

Patients and methods: A prospective, endoscopist-blinded, randomized, controlled study was conducted. Reinforced education groups received additional education via reminders by telephone or SMS 2 days before colonoscopy. The primary outcome was the quality of the bowel preparation according to the Boston Bowel Preparation Scale (BBPS). The secondary outcomes included polyp detection rate (PDR), adenoma detection rate (ADR), tolerance, and subjective feelings of patients.

Results: A total of 390 patients were included. Total BBPS score was significantly higher in the reinforced education groups than in the control group (mean [SD] telephone vs. control: 7.1 [1.2] vs. 6.3 [1.4], P < 0.001; SMS vs. control: 6.8 [1.3] vs. 6.3 [1.4], P = 0.027). Between the two interventions, there was no significant difference in total BBPS score. PDR and ADR were not different among groups. Reinforced education groups showed lower anxiety and better tolerance compared with controls. A preparation-to-colonoscopy time of > 6 hours and < 80 % of the purgative ingested were independent factors associated with inadequate bowel preparation (BBPS < 5), whereas re-education by telephone was inversely related to inadequate bowel preparation.

Conclusion: SMS was the optimal education modality, and was as effective as telephone reminders for the quality of bowel preparation. A reinforced educational approach via telephone or SMS should be individualized, depending on the resource availability of each clinical practice.

Trial registration: ClinicalTrials.gov (NCT01911052).

• References

• 1 Denberg TD, Melhado TV, Coombes JM et al. Predictors of nonadherence to screening colonoscopy. J Gen Intern Med 2005; 20: 989-995
• 2 Harewood GC, Sharma VK, de Garmo P. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. Gastrointest Endosc 2003; 58: 76-79
• 3 Chan WK, Saravanan A, Manikam J et al. Appointment waiting times and education level influence the quality of bowel preparation in adult patients undergoing colonoscopy. BMC Gastroenterol 2011; 11: 86
• 4 Seo EH, Kim TO, Park MJ et al. Optimal preparation-to-colonoscopy interval in split-dose PEG bowel preparation determines satisfactory bowel preparation quality: an observational prospective study. Gastrointest Endosc 2012; 75: 583-590
• 5 Calderwood AH, Lai EJ, Fix OK et al. An endoscopist-blinded, randomized, controlled trial of a simple visual aid to improve bowel preparation for screening colonoscopy. Gastrointest Endosc 2011; 73: 307-314
• 6 Tae JW, Lee JC, Hong SJ et al. Impact of patient education with cartoon visual aids on the quality of bowel preparation for colonoscopy. Gastrointest Endosc 2012; 76: 804-811
• 7 Spiegel BM, Talley J, Shekelle P et al. Development and validation of a novel patient educational booklet to enhance colonoscopy preparation. Am J Gastroenterol 2011; 106: 875-883
• 8 Abuksis G, Mor M, Segal N et al. A patient education program is cost-effective for preventing failure of endoscopic procedures in a gastroenterology department. Am J Gastroenterol 2001; 96: 1786-1790
• 9 Liang X, Wang Q, Yang X et al. Effect of mobile phone intervention for diabetes on glycaemic control: a meta-analysis. Diabet Med 2011; 28: 455-463
• 10 Bobrow K, Brennan T, Springer D et al. Efficacy of a text messaging (SMS) based intervention for adults with hypertension: protocol for the StAR (SMS Text-message Adherence suppoRt trial) randomised controlled trial. BMC Public Health 2014; 14: 28
• 11 Junod PerronN, Dao MD, Righini NC et al. Text-messaging versus telephone reminders to reduce missed appointments in an academic primary care clinic: a randomized controlled trial. BMC Health Serv Res 2013; 13: 125
• 12 Kim HS, Hwang Y, Lee JH et al. Future prospects of health management systems using cellular phones. Telemed J E Health 2014; 20: 544-551
• 13 Liu X, Luo H, Zhang L et al. Telephone-based re-education on the day before colonoscopy improves the quality of bowel preparation and the polyp detection rate: a prospective, colonoscopist-blinded, randomised, controlled study. Gut 2014; 63: 125-130
• 14 Kilgore TW, Abdinoor AA, Szary NM et al. Bowel preparation with split-dose polyethylene glycol before colonoscopy: a meta-analysis of randomized controlled trials. Gastrointest Endosc 2011; 73: 1240-1245
• 15 Ell C, Fischbach W, Bronisch HJ et al. Randomized trial of low-volume PEG solution versus standard PEG + electrolytes for bowel cleansing before colonoscopy. Am J Gastroenterol 2008; 103: 883-893
• 16 Park SS, Sinn DH, Kim YH et al. Efficacy and tolerability of split-dose magnesium citrate: low-volume (2 liters) polyethylene glycol vs. single- or split-dose polyethylene glycol bowel preparation for morning colonoscopy. Am J Gastroenterol 2010; 105: 1319-1326
• 17 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174
• 18 Lai EJ, Calderwood AH, Doros G et al. The Boston Bowel Preparation Scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc 2009; 69: 620-625
• 19 Rex DK, Petrini JL, Baron TH et al. Quality indicators for colonoscopy. Am J Gastroenterol 2006; 101: 873-885
• 20 Wu KL, Rayner CK, Chuah SK et al. Impact of low-residue diet on bowel preparation for colonoscopy. Dis Colon Rectum 2011; 54: 107-112
• 21 Wroe AL. Intentional and unintentional nonadherence: a study of decision making. J Behav Med 2002; 25: 355-372
• 22 Vervloet M, Linn AJ, van Weert JC et al. The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature. J Am Med Inform Assoc 2012; 19: 696-704
• 23 Priyaa S, Murthy S, Sharan S et al. A pilot study to assess perceptions of using SMS as a medium for health information in a rural setting. Technol Health Care 2014; 22: 1-11
• 24 Cormick G, Kim NA, Rodgers A et al. Interest of pregnant women in the use of SMS (short message service) text messages for the improvement of perinatal and postnatal care. Reprod Health 2012; 9: 9
• 25 Siddiqui AA, Yang K, Spechler SJ et al. Duration of the interval between the completion of bowel preparation and the start of colonoscopy predicts bowel-preparation quality. Gastrointest Endosc 2009; 69: 700-706
• 26 Ness RM, Manam R, Hoen H et al. Predictors of inadequate bowel preparation for colonoscopy. Am J Gastroenterol 2001; 96: 1797-1802
• 27 Lebwohl B, Wang TC, Neugut AI. Socioeconomic and other predictors of colonoscopy preparation quality. Dig Dis Sci 2010; 55: 2014-2020
• 28 Hassan C, Fuccio L, Bruno M et al. A predictive model identifies patients most likely to have inadequate bowel preparation for colonoscopy. Clin Gastroenterol Hepatol 2012; 10: 501-506
• 29 Hsueh FC, Wang HC, Sun CA et al. The effect of different patient education methods on quality of bowel cleanliness in outpatients receiving colonoscopy examination. Appl Nurs Res 2014; 27: e1-5
• 30 Kong JH, Ha Y. [Effects of a smoking cessation program including telephone counseling and text messaging using stages of change for outpatients after a myocardial infarction]. J Korean Acad Nurs 2013; 43: 557-567
• 31 Froehlich F, Wietlisbach V, Gonvers JJ et al. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. Gastrointest Endosc 2005; 61: 378-384
• 32 Adler A, Wegscheider K, Lieberman D et al. Factors determining the quality of screening colonoscopy: a prospective study on adenoma detection rates, from 12,134 examinations (Berlin colonoscopy project 3, BECOP-3). Gut 2013; 62: 236-241
• 33 Jover R, Zapater P, Polania E et al. Modifiable endoscopic factors that influence the adenoma detection rate in colorectal cancer screening colonoscopies. Gastrointest Endosc 2013; 77: 381-389 e381
• 34 Clark BT, Rustagi T, Laine L. What level of bowel prep quality requires early repeat colonoscopy: systematic review and meta-analysis of the impact of preparation quality on adenoma detection rate. Am J Gastroenterol 2014; 109: 1714-1723