Patient Factors That Affect Quality of Colonoscopy Preparation

Abstract

Background & Aims Optimal colonoscopy preparation requires patients to adhere to written instructions and be activated to complete the task. Among patients with chronic disease, health literacy and patient activation have been associated with outcome, but these factors have not been studied for colonoscopy. We examined the association between health literacy, patient activation, and quality of bowel preparation. Methods We analyzed outpatient colonoscopy results from 462 adults, 55–74 y old (mean 62±6 y), who previously completed extensive neurocognitive assessments as part of a prospective study (Health Literacy and Cognitive Function in Older Adults). We collected information on cecal intubation, polyp detection, bowel preparation quality, and histopathology. Results One third of the patients (n=134) had suboptimal quality of bowel preparation, 15% (n=62) had fair quality, and 17% (n=72) had poor quality. Limited health literacy was associated with a lower level of education (P<.001), diabetes (P<.001), and a higher number of chronic conditions (P<.001), but not quality of colonoscopy preparation. No baseline characteristics were associated with patient activation. In multivariable analysis, after adjusting for demographics and clinical characteristics, diabetes (odds ratio [OR], 2.93; 95% confidence interval [CI], 1.35–6.36) and patient activation (OR, 2.07; 95% CI, 1.27–3.40) were independent predictors of suboptimal bowel preparation quality, but limited health literacy was not (OR, 0.76; 95% CI, 0.44–1.31). Conclusions We investigated the relationship between health literacy, patient activation, and colonoscopy preparation quality. Lower patient activation was an independent predictor of suboptimal bowel preparation quality. Interventions to improve colonoscopy preparation quality should consider the importance of patient activation within their design.

The clinical effectiveness of different surveillance strategies to prevent colorectal cancer in people with intermediate-grade colorectal adenomas: a retrospective cohort analysis, and psychological and economic evaluations

“…57,58 Risk factors for poor bowel preparation quality include older age, overweight, diabetes and other comorbidities. 59,60 In those individuals for whom colonoscopy is difficult and therefore unsuccessful, it is probably inappropriate to recommend repeated colonoscopic surveillance; alternative surveillance strategies need to be explored.…”

Diabetes Mellitus and Age are Risk Factors of Interval Colon Cancer: A Case-Control Study

“…Indeed, it was demonstrated that the anti-hyperglycemic agent metformin is associated with a decreased incidence of CRC [26]. It is also possible that insufficient bowel preparation, which is potentially more common in DM due to associated autonomic neuropathy and other comorbidities, increases the risk of detection failure [27], although we excluded colonoscopies with inadequate preparation from our analysis.…”

Advances in Bowel Preparation for Colonoscopy

“…In a recent study of nearly 500 outpatients followed either at an academic medical center clinic or a federally qualified health center, low levels of patient activation (OR, 2.12; 1.3-3.45), but not health literacy (OR, 0.76; 0.38-1.52), was an independent predictor of inadequate preparation. 25 The solution to this problem, put succinctly in a recent editorial, is "education, motivation, and reminders." 27 This can be in the form of 1:1 teaching sessions, bowel preparation classes, instructional videos, online tutorials, or in some cases patient navigators.…”

“…21 Additional predictors of inadequate preparation include health literacy and patient activation. [22][23][24][25] Although other variables, such as health insurance status, socioeconomic status, and educational level, have also been observed to predict suboptimal bowel preparation in earlier studies, it is likely that the common denominator is reduced health literacy, which can lead to difficulty or inability to read the educational materials and instructions provided before colonoscopy, failure to comprehend the importance of bowel preparation in the overall success of colonoscopy, or lack of understanding regarding preventive health measures. Patient activation refers to the motivation or mind-set of a patient to participate, or be engaged, in their health care.…”