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2015 HSR&D/QUERI National Conference Abstract

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3066 — A Systematic Review of Patient Education Interventions To Improve Colonoscopy Bowel Preparation

Kurlander JE, Ann Arbor VA, CCMR; Sondhi AR, University of Michigan, Division of Gastroenterology; Waljee AK, Ann Arbor VA, CCMR; Menees SB, University of Michigan, Division of Gastroenterology; Schoenfeld P, Ann Arbor VA, CCMR; Saini SD, Ann Arbor VA, CCMR;

Objectives:
Failed colonoscopy bowel preparation is common, costly, and inconvenient for patients. Patients who fail bowel preparation require repeat colonoscopy with high-volume, 2-day bowel preparation. Experts advocate the use of written and oral instructions for patients before colonoscopy. However, little is known about the most effective method of patient education, and there is no standardized process for pre-colonoscopy education in the VA Health Care System. This systematic review aimed to assess the effectiveness of patient-oriented educational interventions in improving the quality of bowel preparation.

Methods:
Studies were identified from MEDLINE, EMBASE, Cochrane, CINAHL, and Web of Science. Two investigators evaluated each abstract for the following inclusion criteria: evaluation of a patient-oriented educational intervention, prospective design, and measurement of bowel preparation quality with a validated scale. Included studies underwent duplicate data extraction by 2 investigators using a standardized approach. Extracted data included the method of intervention, timing of intervention, staffing of intervention, purgative used, bowel preparation scale used, and bowel preparation quality. Methodological quality of studies was assessed using a modified Downs and Black instrument. Due to significant heterogeneity in assessment of outcomes, meta-analysis was not performed.

Results:
1,080 unique published studies were identified, and 7 of these studies met inclusion criteria. 5 of these 7 studies were randomized controlled trials, and 2 were quasi-experimental. The number of patients analyzed ranged from 99 to 969. 3 interventions used paper-based tools (1 cartoon, 2 illustrated brochures), 2 interventions used videos, 1 intervention used face-to-face education, and 1 used telephone calls. In 6 of the 7 studies, the educational intervention was effective in improving bowel preparation quality. No study accounted for all significant confounders of bowel preparation quality (eg, constipation, diabetes, opiates, socioeconomic status, literacy rate, age, gender, BMI). Only one study was performed in a VA setting. Validity scores ranged from 12-23, with a median value of 18, indicating fair methodological quality.

Implications:
Patient-oriented educational interventions significantly improve bowel preparation, but existing studies are of variable quality and may have limited generalizability.

Impacts:
Health systems should ensure that patients receive evidence-based preparation education. Future studies should focus on comparative effectiveness and cost-effectiveness of educational interventions.