Improving the Quality of Bowel Preparation: Rewarding Patients for Success or Intensive Patient Education?

Abstract

Introduction and Objectives: The quality of the bowel preparation is a critical parameter for the outcome of colonoscopies. It is well established that the bowel preparation modality (e.g., split or larger volume preparation) significantly improves the quality of the bowel preparation. Patient compliance is another important factor impacting on the quality of bowel preparations that receives relatively little research attention. We aimed to explore if intensified education or a lottery ticket as reward for good bowel preparation could improve outcomes. Methods: After informed consent, all patients received a standardized printed information booklet. In a randomized fashion, patients were offered (a) a lottery scratchy ticket with an opportunity to win $25,000 as “reward” for good bowel preparation, (b) an education session delivered over the phone by a trained nurse, or (c) no additional measure. Results: Overall, the quality of the bowel preparation was rated good or very good in 69.1% (95% CI 61.7–75.7%) of patients. Reward intervention did not influence the quality of bowel preparation (OR 0.42, 95% CI 0.09–1.91, p = 0.260); however, bowel preparation quality decreased in patients randomized to receive the additional education (OR 0.28, 95% CI 0.08–0.96, p = 0.042). Neither intervention significantly impacted on polyp detection rates. Conclusions: Contrasting general beliefs, additional interventions (e.g., incentives or phone consultation) did not improve the quality of the bowel preparation. The unexpected result shows that utilizing extra resources must be balanced against real-world outcomes and may not always provide the expected result.

The Colonoscopy Cookbook: Analysis of effect of a recipe resource on quality and experience of bowel preparation in colonoscopy

“…They usually receive bowel preparation instructions via email or over the telephone which may reduce the effectiveness of education on how to undertake bowel preparation when compared to face-to-face explanations [12].…”

“…The most obvious difference between direct access colonoscopy patients and other patients is that direct access patients generally are not seen in the endoscopist rooms prior to their scope. They usually receive bowel preparation instructions via email or over the telephone, which may reduce the effectiveness of education about how to undertake bowel preparation when compared to face-to-face explanations [12]. A further source of bias is the subjectivity of the endoscopist reports and the simplistic analysis terms used.…”

Analysis of Patients Undergoing Colonoscopies and the Importance of Exam Quality for Colorectal Cancer Screening

“…17 The Boston scale is a validated, reliable, and easily reproducible instrument for assessing bowel preparation. 22 Other aspects that impact the quality of colonoscopy exam include application mode, bowel preparation ingredients, and educational techniques. Educating patients is essential, but excessively technical information can make understanding difficult, especially for subjects with lower educational levels.…”

“…Educating patients is essential, but excessively technical information can make understanding difficult, especially for subjects with lower educational levels. 22 Therefore, booklets with simple information about bowel preparation guidelines are valuable and can improve test quality.…”

The unmet needs for identifying the ideal bowel preparation

“… 14 Age, sex, physical activity, socioeconomic status, educational level, and comorbidity may significantly affect colonoscopy quality. 1 , 60 , 61 Predictors of poor BP include age (odds ratio [OR] = 1.14), tobacco use (OR = 1.28), narcotic use (OR = 1.28), hypertension (OR = 1.25), diabetes mellitus (OR = 1.38), obesity (OR = 1.46), low education (OR = 1.49), dementia (OR = 2.09), and calcium‐channel blockers (OR = 3.2), as reported in different reviews and meta‐analyses. 61 , 62 , 63 , 64 Hospitalization is another independent predictor of poor BP.…”