Effect of Text Messaging on Bowel Preparation and Appointment Attendance for Outpatient Colonoscopy

Abstract

IMPORTANCEOutpatient colonoscopy is important for colorectal cancer screening. However, nonadherence and poor bowel preparation are common. OBJECTIVE To determine if an automated text messaging intervention with a focus on informational and reminder functions could improve attendance rates and bowel preparation quality for outpatient colonoscopy. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial was conducted in an endoscopy center at an urban academic medical center. Adult patients scheduled for outpatient colonoscopy between January and September 2019 were enrolled by telephone call (early phase) or by automated text message (late phase). Data were analyzed from October 2019 to January 2020. INTERVENTIONSAfter enrollment, patients were randomized in a 1:1 ratio to usual care (ie, written instructions and nurse telephone call) or to the intervention (ie, usual care plus an automated series of 9 educational or reminder text messages in the week prior to scheduled colonoscopy). MAIN OUTCOMES AND MEASURESThe primary outcome was appointment attendance rate with good or excellent bowel preparation. Secondary outcomes included appointment attendance rate, bowel preparation quality (poor or inadequate, fair or adequate, and good or excellent), and cancellation lead time (in days). RESULTS Among 753 patients included and randomized in the trial (median [interquartile range]age, 56 [49-64] years; 364 [48.3%] men; 429 [57.2%] Black), 367 patients were randomized to the intervention group and 386 patients were randomized to the control group. There was no significant difference in the primary outcome between groups (patients attending appointments with good or excellent bowel preparation: intervention, 195 patients [53.1%]; control, 210 patients [54.4%]; P = .73), including when stratified by early or late phase enrollment groups. Similarly, there were no significant differences in secondary outcomes. CONCLUSIONS AND RELEVANCEThis randomized clinical trial found no significant difference in appointment attendance or bowel preparation quality with an automated text messaging intervention compared with the usual care control. Future work could optimize the content and delivery of text message interventions or identify patient subgroups that may benefit from this approach.

Supplementary education can improve the rate of adequate bowel preparation in outpatients: A systematic review and meta-analysis based on randomized controlled trials

“…The analysis of nine studies [ 12 , 14 , 16 , 23 , 24 , 33 , 35 – 37 ] completed in the USA shows that supplementary education can significantly improve the rate of adequate bowel preparation for outpatients (72.1% vs 67.6%, RR:1.09, 95% CI: 1.01 to 1.19, I 2 = 65%, p = 0.03) ( S6B Fig ). A subgroup analysis based on studies in China [ 7 , 15 , 18 , 19 , 22 , 32 , 34 ] (RR:1.19, 95% CI: 1.10 to 1.28, I 2 = 78%, p <0.00001) and Spain [ 17 , 20 , 21 ] (RR:1.03, 95%CI: 1.01 to 1.06, I 2 = 0%, p = 0.007) also showed that supplementary education can significantly increase the rate of adequate bowel preparation (China: 78.7% vs 68.7% and Spain: 88.8% vs 85.8%) ( S6B Fig ).…”

“…The results of subgroup analysis based on different bowel preparation regimens showed that supplementary education in the 2 L PEG+ ascorbate solution (RR:1.02, 95% CI: 0.97 to 1.07, I 2 = 60%, p = 0.44) group [ 17 , 38 ] could not improve the adequate bowel preparation rate of outpatients ( S6C Fig ). However, in the split-dose 4 L PEG [ 15 , 16 , 18 , 21 – 23 , 32 , 35 ] (75.0% vs 68.7%, RR:1.10, 95% CI: 1.05 to 1.15, I 2 = 43%, p <0.00001) and 4 L PEG [ 7 , 19 , 33 , 37 ] (78.1% vs 64.6%, RR:1.23, 95% CI: 1.10 to 1.38, I 2 = 31%, p = 0.0004) groups, supplementary education improved the rate of adequate bowel preparation ( S6C Fig ).…”

“…As shown in S6F Fig , whether it is based on ACS [ 22 , 23 , 34 , 35 , 37 ] (68.7% vs 63.0%, RR:1.17, 95% CI: 1.02 to 1.34, I 2 = 82%, p = 0.02), BBPS [ 13 , 14 , 16 , 20 , 21 , 32 , 36 , 38 ] (87.4% vs 82.0%, RR:1.09, 95% CI: 1.01 to 1.18, I 2 = 91%, p = 0.03) or OBPQS [ 7 , 12 , 15 , 18 , 19 ] (81.1% vs 65.9%, RR:1.19, 95% CI: 1.14 to 1.25, I 2 = 55%, p <0.00001), supplementary education could significantly improve the rate of adequate bowel preparation for outpatients.…”

“…The results of six low-quality (Jadad 1–3) studies [ 17 , 22 , 24 , 33 , 34 , 37 ] showed that supplementary education can increase the rate of adequate bowel preparation for outpatients (73.2% vs 66.4%, RR:1.21, 95% CI: 1.06 to 1.37, I 2 = 86%, p = 0.004) ( S6G Fig ). The results of fifteen high-quality (Jadad 4–7) studies [ 7 , 12 – 16 , 18 – 21 , 23 , 32 , 35 , 36 , 38 ] also showed that supplementary education can improve patients’ adequate bowel preparation rate (82.2% vs 74.4%, RR:1.13, 95% CI: 1.06 to 1.20, I 2 = 89%, p = 0.0001) ( S6G Fig ).…”

“…A meta-analysis published in 2017 showed that these methods improved the quality of bowel preparation for colonoscopy [ 26 ]. However, several recent randomized controlled trials have found that these measures cannot improve the quality of intestinal preparation for outpatients [ 14 , 21 – 23 ]. To date, there is no meta-analysis on whether supplementary education can improve the rate of adequate bowel preparation for outpatients.…”