Smartphone Application to Reinforce Education Increases High-Quality Preparation for Colorectal Cancer Screening Colonoscopies in a Randomized Trial

Abstract

BACKGROUND & AIMS:Sufficient bowel preparation is crucial for successful screening and surveillance colonoscopy. However, rates of inadequate preparation are still high. We investigated the effects of reinforced patient education using a smartphone application software (APP) for colonoscopy preparation in participants in a CRC screening program. METHODS:We performed a prospective, endoscopist-blinded study of 500 patients undergoing split-dose bowel preparation for CRC screening or surveillance colonoscopies at multiple centers in Germany, from November 2017 through January 2019. Participants (n [ 500) were given oral and written instructions during their initial appointment and then randomly assigned (1:1) to groups that received reinforced education starting 3 days before the colonoscopy (APP group) or no further education (controls). The primary outcome was quality of bowel preparation according to the Boston bowel preparation scale. Secondary outcomes included polyp and adenoma detection rates, compliance with low-fiber diet, split-dose laxative intake, perceived discomfort from the preparation procedure. RESULTS:The mean Boston bowel preparation scale score was significantly higher in the APP-group (7.6 -0.1) than in the control group (6.7 -0.1) (P < .0001). The percentage of patients with insufficient bowel preparation was significantly lower in the APP group (8%) than in the control group (17%) (P [ .0023). The adenoma detection rate was significantly higher in the APP group (35% vs 27% in controls) (P [ .0324). Use of the APP was accompanied by a lower level of non-compliance with correct laxative intake (P [.0080) and diet instructions (P [ .0089). The APP group reported a lower level of discomfort during preparation (P < .0001). CONCLUSIONS:In a randomized trial, reinforcing patient education with a smartphone application optimized bowel preparation in the 3 days before colonoscopy, increasing bowel cleanliness, adenoma detection, and compliance in patients undergoing CRC screening or surveillance. ClinicalTrials. gov no: NCT03290157

Multimedia based education on bowel preparation improves adenoma detection rate: Systematic review & meta‐analysis of randomized controlled trials

“…In one study, patients were provided with educational video‐clips via an internet blog to be viewed on their smartphones 34 . In other studies, a separate smartphone application such as ‘Lanniu Medical Care’, 35 mobile messenger (‘SMM, KakaoTalk’), 30 ‘WeChat’ 31,32 and ‘MoviePrep’ 21 was utilized for patient education. In two other studies, a novel 36 and customizable 37 smartphone application was used.…”

“…2). Furthermore, sub‐group analysis of six studies that reported both on ADR and adequacy of bowel preparation 21,30–33,35 was performed. A significantly higher proportion of patients in the MM cohort had adequate bowel preparation compared to CT cohort (RR 1.2 CI 1.1–1.3; I 2 = 50; P = 0.001) (Fig.…”

“…ADR, as put forth by gastrointestinal societies such as ASGE and ACG. The studies included in the meta‐analysis were performed at different geographic locations around the world – Europe, 21 USA 38 and China, 35 thus making the results more generalizable.…”

“…and (v) studies not published in the English language. In cases of multiple publications from a single research group reporting on the same patient, same cohort and/or overlapping cohorts, data from the most recent report were retained 20,21 …”

“…In cases of multiple publications from a single research group reporting on the same patient, same cohort and/or overlapping cohorts, data from the most recent report were retained. 20,21 Data abstraction and quality assessment Data on study-related outcomes from the individual studies were abstracted independently onto a standardized form by at least two authors (SC, SRK). Authors (OCC, SA) crossverified the collected data for possible errors and two authors (SC, SRK) did the quality scoring independently.…”