Colonoscopy education delivered via the patient portal does not improve adherence to scheduled first-time screening colonoscopy

Abstract

Background and study aims Non-adherence to scheduled colonoscopy burdens endoscopic practices and innovative approaches to improve adherence are needed. We aimed to assess the effect of an educational video emphasizing colonoscopy importance delivered through the electronic health record patient portal upon “no-show” and late cancellation rates (non-adherence) in patients scheduled for first-time screening colonoscopy.

Patients and methods We conducted a single center randomized controlled trial among patients scheduled for their first screening colonoscopy. Patients were randomized to routine care (“control”) or video education (“video”). Control patients received a portal message 14 days prior to colonoscopy date; video patients additionally received a link to the educational video.

Results In total, 830 patients (59 % female, median age 55 years) were randomized (“control”: 406; “video”: 424). Nearly all (88 %) opened the message; in the video arm, most (72 %) watched a majority of the video. Overall, 80 % attended their scheduled colonoscopy appointment (late cancel: 18 %, “no show”: 1 %) and 90 % underwent colonoscopy within 3 months of appointment. Adherence rates did not differ between video and control arms for the scheduled appointment (OR 1.2, CI 0.9–1.8) or for colonoscopy within 3 months of scheduled appointment (OR 1.3, CI 0.8–2.1). Bowel preparation quality did not differ between the groups.

Conclusion Most patients scheduled for colonoscopy will open a patient portal message and, when delivered, watch an educational video. However, delivery of an educational video two weeks prior to screening colonoscopy appointment did not improve adherence.

• References

• 1 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016; 66: 7-30
• 2 Liang PS, Wheat CL, Abhat A. et al. Adherence to competing strategies for colorectal cancer screening over 3 years. Am J Gastroenterol 2016; 111: 105-114
• 3 Karlitz JJ, Oliphant AB, Greenwald DA. et al. The American College of Gastroenterology and the 80% by 2018 colorectal cancer initiative: a multifaceted approach to maximize screening rates. Am J Gastroenterol 2017; 112: 1360-1362
• 4 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
• 5 Cameron KA, Francis L, Wolf MS. et al. Investigating Hispanic/Latino perceptions about colorectal cancer screening: a community-based approach to effective message design. Patient Educ Couns 2007; 68: 145-152
• 6 Makoul G, Cameron KA, Baker DW. et al. A multimedia patient education program on colorectal cancer screening increases knowledge and willingness to consider screening among Hispanic/Latino patients. Patient Educ Couns 2009; 76: 220-226
• 7 Cameron KA, Persell SD, Brown T. et al. Patient outreach to promote colorectal cancer screening among patients with an expired order for colonoscopy: a randomized controlled trial. Arch Intern Med 2011; 171: 642-646
• 8 Dolan NC, Ramirez-Zohfeld V, Rademaker AW. et al. The effectiveness of a physician-only and physician-patient intervention on colorectal cancer screening discussions between providers and African American and Latino patients. J Gen Intern Med 2015; 30: 1780-1787
• 9 Brown T, Goldman SN, Persell SD. et al. Development and evaluation of a patient education video promoting pneumococcal vaccination. Patient Educ Couns 2017; 100: 1024-1027
• 10 Fortuna RJ, Idris A, Winters P. et al. Get screened: a randomized trial of the incremental benefits of reminders, recall, and outreach on cancer screening. J Gen Intern Med 2014; 29: 90-97
• 11 Sequist TD, Zaslavsky AM, Marshall R. et al. Patient and physician reminders to promote colorectal cancer screening: a randomized controlled trial. Arch Intern Med 2009; 169: 364-371
• 12 Senore C, Inadomi J, Segnan N. et al. Optimising colorectal cancer screening acceptance: a review. Gut 2015; 64: 1158-1177
• 13 Sequist TD, Zaslavsky AM, Colditz GA. et al. Electronic patient messages to promote colorectal cancer screening: a randomized controlled trial. Arch Intern Med 2011; 171: 636-641
• 14 Baker DW, Brown T, Buchanan DR. et al. Comparative effectiveness of a multifaceted intervention to improve adherence to annual colorectal cancer screening in community health centers: a randomized clinical trial. JAMA Intern Med 2014; 174: 1235-1241
• 15 Tieu L, Schillinger D, Sarkar U. et al. Online patient websites for electronic health record access among vulnerable populations: portals to nowhere?. J Am Med Inform Assoc 2017; 24: e47-e54
• 16 Taha J, Sharit J, Czaja SJ. The impact of numeracy ability and technology skills on older adultsʼ performance of health management tasks using a patient portal. J Appl Gerontol 2014; 33: 416-436
• 17 Lyles CR, Fruchterman J, Youdelman M. et al. Legal, practical, and ethical considerations for making online patient portals accessible for all. Am J Public Health 2017; 107: 1608-1611
• 18 Serper M, Gawron AJ, Smith SG. et al. Patient factors that affect quality of colonoscopy preparation. Clin Gastroenterol Hepatol 2014; 12: 451-457
• 19 Wu Y, Liang Y, Zhou Q. et al. Effectiveness of a short message service intervention to motivate people with positive results in preliminary colorectal cancer screening to undergo colonoscopy: A randomized controlled trial. Cancer 2019; DOI: 10.1002/cncr.32043.
• 20 Walter B, Klare P, Strehle K. et al. Improving the quality and acceptance of colonoscopy preparation by reinforced patient education with short message service: results from a randomized, multicenter study (PERICLES-II). Gastrointest Endosc 2019; 89: 506-513 e504
• 21 Ritvo PG, Myers RE, Paszat LF. et al. Personal navigation increases colorectal cancer screening uptake. Cancer Epidemiol Biomarkers Prev 2015; 24: 506-511
• 22 Chen LA, Santos S, Jandorf L. et al. A program to enhance completion of screening colonoscopy among urban minorities. Clin Gastroenterol Hepatol 2008; 6: 443-450
• 23 DeGroff A, Schroy 3rd PC, Morrissey KG. et al. Patient navigation for colonoscopy completion: results of an RCT. Am J Prev Med 2017; 53: 363-372
• 24 Green BB, Wang CY, Anderson ML. et al. An automated intervention with stepped increases in support to increase uptake of colorectal cancer screening: a randomized trial. Ann Intern Med 2013; 158: 301-311
• 25 Blumenthal DM, Singal G, Mangla SS. et al. Predicting non-adherence with outpatient colonoscopy using a novel electronic tool that measures prior non-adherence. J Gen Intern Med 2015; 30: 724-731
• 26 Partin MR, Gravely A, Gellad ZF. et al. Factors associated with missed and cancelled colonoscopy appointments at Veterans Health Administration facilities. Clin Gastroenterol Hepatol 2016; 14: 259-267
• 27 Parker S, Zipursky J, Ma H. et al. A web-based multimedia program before colonoscopy increased knowledge and decreased anxiety, sedation requirement, and procedure time. J Clin Gastroenterol 2018; 52: 519-523