Download PDF
Endoscopy 2021; 53(03): 254-263
DOI: 10.1055/a-1225-8708
Original article

Computer-based patient education is non-inferior to nurse counselling prior to colonoscopy: a multicenter randomized controlled trial

Govert Veldhuijzen
1   Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
,
Michael Klemt-Kropp
2   Department of Gastroenterology and Hepatology, Northwest Hospital Group, Alkmaar, The Netherlands
,
Jochim S. Terhaar sive Droste
3   Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
,
Bas van Balkom
4   Department of Gastroenterology and Hepatology, Bernhoven Hospital, Uden, The Netherlands
,
Aura A. J. van Esch
1   Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
,
Joost P. H. Drenth
1   Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
› Author AffiliationsTrial Registration: Netherlands Trial Register Registration number (trial ID): NTR5475 Type of study: Prospective, multicenter, endoscopist blinded, non-inferiority randomized controlled study.
› Further Information
Also available at
    Permissions and Reprints

Referred to by:

Patient education for colonoscopy in the time of computers: are you ready, player one?Endoscopy 2021; 53(03): 264-265
DOI: 10.1055/a-1261-9632

Abstract

Background Optimal patient education prior to colonoscopy improves adherence to instructions for bowel preparation and leads to cleaner colons. We developed computer-based education (CBE) supported by video and 3 D animations. We hypothesized that CBE could replace nurse counselling without loss of bowel preparation quality during colonoscopy.

Methods We conducted a prospective, multicenter, endoscopist-blinded, non-inferiority randomized controlled trial. The primary outcome was adequate bowel preparation, evaluated using the Boston Bowel Preparation Scale (BBPS). Secondary outcome measures were: sickness absence for outpatient clinic visits; patient anxiety/satisfaction scores; and information recall. We included patients in four endoscopy units (rural, urban, and tertiary).

Results We screened 1035 eligible patients and randomized 845. After evaluation, 684 were included in the intention-to-treat (ITT) group. Subsequently, 497 patients were included in the per-protocol analysis, 217 in the nurse counselling and 280 in the CBE group. Baseline characteristics were similarly distributed among the groups. On per-protocol analysis, adequate bowel cleansing was achieved in 93.2 % (261/280) of CBE patients, which was non-inferior to nurse-counselled patients (94.0 %; 204/217), with a difference of −0.8 % (95 % confidence interval [CI] −5.1 % to 3.5 %). Non-inferiority was confirmed in the ITT population. Sickness absence was significantly more frequent in nurse-counselled patients (28.0 % vs. 4.8 %). In CBE patients, 21.5 % needed additional information, with 3.0 % needing an extra outpatient visit.

Conclusion CBE is non-inferior to nurse counselling in terms of bowel preparation during colonoscopy, with lower patient sickness leave. CBE may serve as an efficient educational tool to inform patients before colonoscopy in routine clinical practice.

Appendix 1 – 3, Tables 1s – 5s



Publication History

Received: 25 November 2019

Accepted: 23 July 2020

Accepted Manuscript online:
23 July 2020

Article published online:
05 November 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Corley DA, Jensen CD, Marks AR. et al. Adenoma detection rate and risk of colorectal cancer and death. NEJM 2014; 370: 1298-1306
    CrossrefPubMedGoogle Scholar
  • 2 Rex DK, Imperiale TF, Latinovich DR. et al. Impact of bowel preparation on efficiency and cost of colonoscopy. Am J Gastroenterol 2002; 97: 1696-1700
    CrossrefPubMedGoogle Scholar
  • 3 Rosenfeld G, Krygier D, Enns RA. et al. The impact of patient education on the quality of inpatient bowel preparation for colonoscopy. Can J Gastroenterol 2010; 24: 543-546
    CrossrefPubMedGoogle Scholar
  • 4 Rex DK. Optimal bowel preparation--a practical guide for clinicians. Nat Rev Gastroenterol Hepatol 2014; 11: 419-425
    CrossrefPubMedGoogle Scholar
  • 5 Waldmann E, Penz D, Majcher B. et al. Impact of high-volume, intermediate-volume and low-volume bowel preparation on colonoscopy quality and patient satisfaction: An observational study. United European Gastroenterol J 2019; 7: 114-124
    CrossrefPubMedGoogle Scholar
  • 6 Liu Z, Zhang MM, Li YY. et al. Enhanced education for bowel preparation before colonoscopy: A state-of-the-art review. J Dig Dis 2017; 18: 84-91
    CrossrefPubMedGoogle Scholar
  • 7 Abuksis G, Mor M, Segal N. et al. A patient education program is cost-effective for preventing failure of endoscopic procedures in a gastroenterology department. Am J Gastroenterol 2001; 96: 1786-1790
    CrossrefPubMedGoogle Scholar
  • 8 Stratmann K, Bock H, Filmann N. et al. Individual invitation letters lead to significant increase in attendance for screening colonoscopies: Results of a pilot study in Northern Hesse, Germany. United European Gastroenterol J 2018; 6: 1082-1088
    CrossrefPubMedGoogle Scholar
  • 9 Suhling H, Rademacher J, Zinowsky I. et al. Conventional vs. tablet computer-based patient education following lung transplantation--a randomized controlled trial. PLoS One 2014; 9: e90828
    CrossrefPubMedGoogle Scholar
  • 10 Veldhuijzen G, van Esch AA, Klemt-Kropp M. et al. E-Patient Counseling Trial (E-PACO): Computer based education versus nurse counseling for patients to prepare for colonoscopy. J Vis Exp 2019; DOI: 10.3791/58798.
    CrossrefPubMedGoogle Scholar
  • 11 Veldhuijzen G, Klemt-Kropp M, Noomen C. et al. Computer-assisted instruction before colonoscopy is as effective as nurse counselling, a clinical pilot trial. Endosc Int Open 2017; 5: E792-E797
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Fox MP. A systematic review of the literature reporting on studies that examined the impact of interactive, computer-based patient education programs. Patient Educ Couns 2009; 77: 6-13
    CrossrefPubMedGoogle Scholar
  • 13 Munsterman ID, Cleeren E, van der Ploeg T. et al. 'Pico-Bello-Klean study': effectiveness and patient tolerability of bowel preparation agents sodium picosulphate-magnesium citrate and polyethylene glycol before colonoscopy. A single-blinded randomized trial. Eur J Gastroenterol Hepatol 2015; 27: 29-38
    CrossrefPubMedGoogle Scholar
  • 14 van der Vaart R, Drossaert CH, Taal E. et al. Validation of the Dutch functional, communicative and critical health literacy scales. Patient Educ Couns 2012; 89: 82-88
    CrossrefPubMedGoogle Scholar
  • 15 Bouwmans C, Krol M, Severens H. et al. The iMTA Productivity Cost Questionnaire: A standardized instrument for measuring and valuing health-related productivity losses. Value Health 2015; 18: 753-758
    CrossrefPubMedGoogle Scholar
  • 16 Spielberger CD, Gorsuch R, Lushene RE, Vagg PR. Manual for the State-Trait Anxiety Inventory. Palo Alto, California, USA: Consulting Psychologists Press; 1983
    Google Scholar
  • 17 Mittal S. The Boston Bowel Preparation Scale: reliable not only for colonoscopy-oriented research but clinical practice also. Gastrointest Endosc 2010; 71: 221
    CrossrefPubMedGoogle Scholar
  • 18 Krol MW, de Boer D, Delnoij DM. et al. The Net Promoter Score - an asset to patient experience surveys?. Health Expect 2015; 18: 3099-3109
    CrossrefPubMedGoogle Scholar
  • 19 Schreiber S, Baumgart DC, Drenth JPH. et al. Colon cleansing efficacy and safety with 1 L NER1006 versus sodium picosulfate with magnesium citrate: a randomized phase 3 trial. Endoscopy 2019; 51: 73-84
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Loftus R, Nugent Z, Graff LA. et al. Patient satisfaction with the endoscopy experience and willingness to return in a central Canadian health region. Can J Gastroenterol 2013; 27: 259-266
    CrossrefPubMedGoogle Scholar
  • 21 DeMicco MP, Clayton LB, Pilot J. et al. Novel 1 L polyethylene glycol-based bowel preparation NER1006 for overall and right-sided colon cleansing: a randomized controlled phase 3 trial versus trisulfate. Gastrointest Endosc 2018; 87: 677-687 e673
    CrossrefPubMedGoogle Scholar
  • 22 Walter B, Klare P, Strehle K. et al. Improving the quality and acceptance of colonoscopy preparation by reinforced patient education with short message service: results from a randomized, multicenter study (PERICLES-II). Gastrointest Endosc 2019; 89: 506-513 e504
    CrossrefPubMedGoogle Scholar
  • 23 Richter JM, Ha JB, Marx M. et al. A digital preprocedure instruction program for outpatient colonoscopy. Telemed J E Health 2020; 26: 468-476
    CrossrefPubMedGoogle Scholar
  • 24 Lorenzo-Zuniga V, Moreno de Vega V, Marin I. et al. Improving the quality of colonoscopy bowel preparation using a smart phone application: a randomized trial. Dig Endosc 2015; 27: 590-595
    CrossrefPubMedGoogle Scholar
  • 25 Sharara AI, Chalhoub JM, Beydoun M. et al. A customized mobile application in colonoscopy preparation: a randomized controlled trial. Clin Transl Gastroenterol 2017; 8: e211
    CrossrefPubMedGoogle Scholar
  • 26 Desai M, Nutalapati V, Bansal A. et al. Use of smartphone applications to improve quality of bowel preparation for colonoscopy: a systematic review and meta-analysis. Endosc Int Open 2019; 7: E216-E224
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Nelson MJ, Keswani RN. Inadequate colonoscopy preparation: Is it time to send out an SMS?. Gastrointest Endosc 2019; 89: 514-517
    CrossrefPubMedGoogle Scholar
  • 28 MacArthur KL, Leszczynski AM, Jacobson BC. Enhancing bowel preparation instructions: Is the bang worth the buck, or are we stuck with the muck?. Gastrointest Endosc 2017; 85: 98-100
    CrossrefPubMedGoogle Scholar
  • 29 Johnson DA, Barkun AN, Cohen LB. et al. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer. Am J Gastroenterol 2014; 109: 1528
    CrossrefPubMedGoogle Scholar
  • 30 Back SY, Kim HG, Ahn EM. et al. Impact of patient audiovisual re-education via a smartphone on the quality of bowel preparation before colonoscopy: a single-blinded randomized study. Gastrointest Endosc 2018; 87: 789-799 e784
    CrossrefPubMedGoogle Scholar
  • 31 de Jong MJ, van der Meulen-de Jong AE, Romberg-Camps MJ. et al. Telemedicine for management of inflammatory bowel disease (myIBDcoach): a pragmatic, multicentre, randomised controlled trial. Lancet 2017; 390: 959-968
    CrossrefPubMedGoogle Scholar
  • 32 Sangrar R, Docherty-Skippen SM, Beattie K. Blended face-to-face and online/computer-based education approaches in chronic disease self-management: A critical interpretive synthesis. Patient Educ Couns 2019; 102: 1822-1832
    CrossrefPubMedGoogle Scholar
  • 33 V&VN. Rapport Arbeidsmarkt 2019 [In Dutch]. https://www.uwv.nl/overuwv/Images/factsheet-arbeidsmarkt-zorg-maart2020.pdf Accessed: 9 September 2020
    PubMedGoogle Scholar
  • 34 Toes-Zoutendijk E, van Leerdam ME, Dekker E. et al. Real-time monitoring of results during first year of Dutch colorectal cancer screening program and optimization by altering fecal immunochemical test cut-off levels. Gastroenterology 2017; 152: 767-775 e762
    CrossrefPubMedGoogle Scholar
  • 35 Jain D, Singhal S. Factors affecting bowel preparation and adenoma detection: patient or the doctor. Gastrointest Endosc 2015; 82: 583
    CrossrefPubMedGoogle Scholar