The Impact of Patient Education on the Quality of Inpatient Bowel Preparation for Colonoscopy

Rosenfeld, Greg; Krygier, Darin; Enns, Robert; Singham, Janakie; Wiesinger, H; Bressler, Brian

doi:10.1155/2010/718628

Cited by 84 publications

(65 citation statements)

References 12 publications

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“…16 Education programmes have been proved to be efficient in improving bowel cleansing preparation. [17][18][19] Such interventions are easy to implement and inexpensive. The utilization of written documents, demonstrative pictures, electronic presentations, and/or videos might be useful.…”

Section: Discussionmentioning

confidence: 99%

Factors related to bowel cleansing failure before colonoscopy: Results of the PACOME study

et al. 2014

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Background: The factors associated with inadequate bowel cleansing leading to colonoscopy failure are not well known. Objective: We conducted a multicentre, prospective, observational case-control study in order to identify these factors. Methods: Investigators included one patient with colonoscopy failure due to inadequate bowel cleansing (failure group) and the following patient with complete colonoscopy (success group). Data related to demographics, medical history, and preparation were collected and compared. Factors associated with bowel cleansing failure were identified by multivariate logistical regression analysis. Results: A total of 101 gastroenterologists included 202 patients from 1 November 2009 to 15 January 2010. There was no difference between both groups with regards to baseline characteristics. In univariate analysis, factors significantly associated with bowel cleansing failure were vomiting during preparation (p ¼ 0.0007), incomplete intake of the preparation (p ¼ 0.002), and constipation (p ¼ 0.02). Type and timing of preparation were not significantly different between groups. In multivariate analysis, incomplete intake of the preparation (OR 4.5, 95% CI 1.2-17.3), constipation (OR 4.2, 95% CI 1.2-14.9), and treatment with neuroleptics or antidepressants (OR 9.9 (95% CI 1.4-71.0) were independent predictors of colonoscopy failure. Conclusions: Factors associated with bowel cleansing failure were incomplete intake of the preparation, constipation, and treatment with psychotropic drugs. Interventions to reduce poor colonoscopy preparations should be targeted at these at-risk patients.

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Section: Discussionmentioning

confidence: 99%

Factors related to bowel cleansing failure before colonoscopy: Results of the PACOME study

et al. 2014

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“…A lower education level, as a marker of lower socioeconomic status, was recently shown to be an independent predictor of poor bowel preparation in an Asian study of 501 outpatients [67] . In contrast, enhanced education and specific counseling of adult patients on bowel preparation instructions was shown to improve the quality of bowel preparation in an elegant Canadian study of 38 patients [76] .…”

Section: Socioeconomic Statusmentioning

confidence: 99%

“…The setting in which patients are referred for a colonoscopy, i.e., either from an in-patient or out-patient setting, is yet another surrogate marker for the impact of co-morbidity on level of colon cleanliness. Inpatient status has been associated with poorer bowel preparation in several studies [65,67,76] , and this has been attributed to prolonged immobility and poor tolerance to purgatives due to co-morbid illness. Even in colonic surgery, an outpatient bowel preparation, as opposed to an in-patient preparation, has been shown to result in a better clinical outcome due increased co-morbidity in the latter [77] .…”

Section: Appointment Waiting Timementioning

confidence: 99%

Factors influencing quality of bowel preparation for colonoscopy

Romero

Mahadeva

2013

WJGE

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Recent technological advances in colonoscopy have led to improvements in both image enhancement and procedural performance. However, the utility of these technological advancements remain dependent on the quality of bowel preparation during colonoscopy. Poor bowel preparation has been shown to be associated with lower quality indicators of colonoscopy performance, such as reduced cecal intubation rates, increased patient discomfort and lower adenoma detection. The most popular bowel preparation regimes currently used are based on either Polyethylene glycol-electrolyte, a non-absorbable solution, or aqueous sodium phosphate, a lowvolume hyperosmotic solution. Statements from various international societies and several reviews have suggested that the efficacy of bowel preparation regimes based on both purgatives are similar, although patients' compliance with these regimes may differ somewhat. Many studies have now shown that factors other than the type of bowel preparation regime used, can influence the quality of bowel preparation among adult patients undergoing colonoscopy. These factors can be broadly categorized as either patient-related or procedure-related. Studies from both Asia and the West have identified patient-related factors such as an increased age, male gender, presence of co-morbidity and socioeconomic status of patients to be associated with poor bowel preparation among adults undergoing routine out-patient colonoscopy. Additionally, procedure-related factors such as adherence to bowel preparation instructions, timing of bowel purgative administration and appointment waiting times for colonoscopy are recognized to influence the quality of colon cleansing. Knowledge of these factors should aid clinicians in modifying bowel preparation regimes accordingly, such that the quality of colonoscopy performance and delivery of service to patients can be optimised.

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“…In one randomized study, inpatients received standardized written instructions before colonoscopy, and one group additionally received a 5-min counseling session, explaining the importance of an adequate preparation. This intervention achieved significantly better bowel cleanliness scores [70] .…”

Section: Will a More Informed Patient Have A Better-prepared Colon?mentioning

confidence: 86%

Achieving the best bowel preparation for colonoscopy

Parra‐Blanco¹,

Ruiz²,

Álvarez-Lobos³

et al. 2014

WJG

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Bowel preparation is a core issue in colonoscopy, as it is closely related to the quality of the procedure. Patients often find that bowel preparation is the most unpleasant part of the examination. It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions. In spite of its importance and potential implications, until recently, bowel preparation has not been the subject of much study. The most commonly used agents are high-volume polyethylene glycol (PEG) electrolyte solution and sodium phosphate. There has been some confusion, even in published meta-analyses, regarding which of the two agents provides better cleansing. It is clear now that both PEG and sodium phosphate are effective when administered with proper timing. Consequently, the timing of administration is recognized as one of the central factors to the quality of cleansing. The bowel preparation agent should be administered, at least in part, a few hours in advance of the colonoscopy. Several low volume agents are available, and either new or modified schedules with PEG that usually improve tolerance. Certain adjuvants can also be used to reduce the volume of PEG, or to improve the efficacy of other agents. Other factors apart from the choice of agent can improve the quality of bowel cleansing. For instance, the effect of diet before colonoscopy has not been completely clarified, but an exclusively liquid diet is probably not required, and a low-fiber diet may be preferable because it improves patient satisfaction and the quality of the procedure. Some patients, such as diabetics and persons with heart or kidney disease, require modified procedures and certain precautions. Bowel preparation for pediatric patients is also reviewed here. In such cases, PEG remains the most commonly used agent. As detecting neoplasia is not the main objective with these patients, less intensive preparation may suffice. Special considerations must be made for patients with inflammatory bowel disease, including safety and diagnostic issues, so that the most adequate agent is chosen. Identifying neoplasia is one of the main objectives of colonoscopy with these patients, and the target lesions are often almost invisible with white light endoscopy. Therefore excellent quality preparation is required to find these lesions and to apply advanced methods such as chromoendoscopy. Bowel preparation for patients with lower gastrointestinal bleeding represents a challenge, and the strategies available are also reviewed here. Core tip: Bowel preparation for colonoscopy is a central issue related to the quality of the procedure. There are different agents for bowel preparation that can be administered with different schedules. We review the most commonly used agents, as well as new agents and combinations. Moreover, certain considerations should be taken into account for special populations in order to improve safety, efficacy and tolerance. Regimens for bowel preparation in special situations are discussed, such as for pedi...

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The Impact of Patient Education on the Quality of Inpatient Bowel Preparation for Colonoscopy

Abstract: Patient counselling and written instructions are inexpensive, safe and simple interventions. Such interventions are an effective means of optimizing colonoscopy preparation in the inpatient setting.

Cited by 84 publications

References 12 publications

Factors related to bowel cleansing failure before colonoscopy: Results of the PACOME study

Factors related to bowel cleansing failure before colonoscopy: Results of the PACOME study

Factors influencing quality of bowel preparation for colonoscopy

Achieving the best bowel preparation for colonoscopy

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