Predictors of patient reluctance to wake early in the morning for bowel preparation for colonoscopy: a precolonoscopy survey in city-wide practice

Abstract

Introduction Many endoscopists do not use split-dose bowel preparation (SDBP) for morning colonoscopies. Despite SDBP being recommended practice, they believe patients will not agree to take early morning bowel preparation (BP). We assessed patients’ opinions about waking early for BP. Methods A self-administered survey was distributed between 08/2015 and 06/2016 to patients in Winnipeg, Canada when they attended an outpatient colonoscopy. Logistic regression was performed to determine predictors of reluctance to use early morning BP. Results Of the 1336 respondents (52 % female, median age 57 years), 33 % had used SDBP for their current colonoscopy. Of the 1336, 49 % were willing, 24 % neutral, and 27 % reluctant to do early morning BP. Predictors of reluctant versus willing were number of prior colonoscopies (OR 1.20; 95 %CI: 1.07 – 1.35), female gender (OR 1.65; 95 %CI: 1.19 – 2.29), unclear BP information (OR 1.86; 95 %CI: 1.21 – 2.85), high BP anxiety (OR 2.02; 95 %CI: 1.35 – 3.02), purpose of current colonoscopy being bowel symptoms (OR 1.40; 95 %CI: 1.00 – 1.97), use of 4 L of polyethylene glycol laxative (OR 1.45; 95 %CI: 1.02 – 2.06), not having SDBP (OR 1.96; 95 %CI: 1.31 – 2.93), and not having finished the laxative for the current colonoscopy (OR 1.66; 95 %CI: 1.01 – 2.73). Most of the same predictors were identified when reluctance was compared to willing or neutral, and in ordinal logistic regression. Conclusions Almost three-quarters of patients do not express reluctance to get up early for BP. Among those who are reluctant, improving BP information, allaying BP-related anxiety, and use of low volume BP may increase acceptance of SDBP.

Mandatory vs. optional split-dose bowel preparation for morning colonoscopies: a pragmatic noninferiority randomized controlled trial

“…We have shown regardless of early or late morning procedures, when given a choice (optional SDBP), patients are more likely to choose taking the laxative entirely the day before. This is not surprising, as we have previously shown in a survey of 1336 respondents, that unclear BP information (OR 1.86, 95% CI, 1.21-2.85) and high BP anxiety (OR 2.02, 95% CI, 1.35-3.02) are predictors of patient reluctance to use early morning BP [32]. Our studies suggest the need to provide additional information to patients, highlighting the benefits of SDBP.…”

Tolerance to colonoscopy preparation with Fortrans and predictors of negative effects

“…показали, что пробуждение и прием препарата в ранние утренние часы у 1/3 пациентов, готовящихся к колоноскопии сплит-методом, вызывают негативную реакцию. Это не могло не сказаться на их оценке удовлетворенности этим способом подготовки [14].…”

Information experiences, needs, and preferences of colonoscopy patients

“…Based on the results of this study and other studies that are part of the larger overall project [16,17] as well as literature review, we have developed (with input from patients, health care providers, our advisory committees) patient-friendly written information, downloadable pages, and brief videos to demonstrate optimal BP, information about the procedure, and common findings to address common concerns and answer common questions for patients. These resources are freely available on the web (http://www.mycolonoscopy.ca/) and are in comparative analyses preferred by patients than previous materials (data will be reported in separate manuscript).…”

“…We have previously reported on the patients’ opinions about waking up for BP early in the morning, factors associated with reluctance to conduct early morning BP, magnitude of anxiety and factors associated with anxiety related to different aspects of the colonoscopy process. [16,17] For this report, we analyzed the information needs and experiences of patients undergoing colonoscopy.…”