Texting to Improve Colonoscopy Preparation and Adherence Needs More Study

Abstract

This study by Mahmud and colleagues 1 describes results of their randomized clinical trial to determine whether a text message intervention could reduce colonoscopy nonattendance and improve bowel preparation quality. Among 753 patients in Philadelphia, Pennsylvania, undergoing outpatient colonoscopy, the intervention failed to improve appointment adherence as well as bowel preparation quality compared with usual care. Overall, 195 of 387 patients (53.1%) receiving the intervention texts and 210 of 386 patients (54.4%) in the usual care control group kept their appointment with either good or excellent bowel preparation. 1 Furthermore, no significant differences were found in any secondary outcomes, such as individual components of appointment adherence, bowel preparation quality, colonoscopy reschedule rates, and cancellation lead time. 1 Annually, an estimated 15 million screening, surveillance, and diagnostic colonoscopies are performed annually in the United States, 2 associated with a decline in colorectal cancer mortality, the second leading cause of cancer-related death. 3 Colonoscopies are the most frequently used colorectal cancer screening test in the United States.Although the findings in the study by Mahmud et al 1 were negative, they inform future research by highlighting critical issues. First, by comparing texting with previous studies in which texting (or a similar intervention) was effective, we could better understand the intervention's key aspects (and/or study population) and work toward future effectiveness. For example, a pilot study by these authors of a nearly identical text intervention yielded improved colonoscopy show rates. 4 Additionally, numerous other studies have found text messaging to be effective for appointment attendance. 5 Second, with colonoscopies already in high demand (and demand expected to increase), interventions to reduce nonattendance are critically needed. This expectation is partly owing to recent recommendations that the starting age for colorectal cancer screening be lowered from age 50 years to age 45 years. 3

Bootstrapping a Conversational Guide for Colonoscopy Prep

“…Engaging patients with automatic text reminders greatly improved colonoscopy prep adherence (90% vs. 62%) when patients were invited to ask follow up questions with health-care providers (Mahmud et al, 2019), but a larger scale trial where patients were not invited to reply to the text messages (for lack of personnel) found no improvements over the control group (Mahmud et al, 2021). The capacity to answer questions-which we seek to automate for the first time-appears to have been the crucial difference (Clancy and Dominitz, 2021).…”