Smartphone app helps patients adhere to colonoscopy prep
A smartphone application helped reinforce patient education in the days preceding colonoscopy, resulting in better bowel cleanliness and adenoma detection, according to research published in Clinical Gastroenterology and Hepatology.
Benjamin M. Walter, MD, of Klinik für Innere Medizin in Germany, and colleagues wrote that sufficient bowel preparation is a critical factor in the success of colorectal cancer screening, but still relies on patient compliance.
“Important impediments reported by patients are uncertainties with dietary recommendations and adverse gastrointestinal symptoms associated with purgatives,” they wrote. “Hence, it is not surprising that inadequate bowel preparation is reported in up to 25% of all patients undergoing colonoscopy. Precise patient education and close guidance are therefore valuable tools that enable patients to follow the bowel preparation instructions accurately.”
Researchers performed a prospective, endoscopist-blinded study to investigate the effects of reinforced patient education using a smartphone application among 500 patients who underwent split-dose bowel prep for CRC screening or surveillance colonoscopy.
Investigators provided oral and written instructions to patients during their initial appointment and then randomly assigned them to receive reinforced education using the app or no further education. The primary outcome of the study was quality of bowel preparation according to the Boston bowel preparation scale (BBPS). Researchers also explored polyp and adenoma detection rates, compliance with low-fiber diet, split-dose laxative intake and perceived discomfort from the preparation procedure.
Compared with the control group, the app group had a higher mean BBPS (6.7±0.1 vs. 7.6±0.1; P < .0001) and a lower percentage of patients with insufficient bowel preparation (17% vs. 8%; P = .0023). The adenoma detection rate within the app group was also higher than in the control group (35% vs. 27%; P = .0324).
Walter and colleagues also found that individuals in the app group had lower levels of non-compliance with correct laxative intake (P = .008) and diet instructions (P = .0089), as well as a lower level of discomfort during preparation (P < .0001).
“[The app] was as an effective, well-accepted, and less resource-demanding tool for improving bowel preparation quality in a CRC-screening and surveillance program. This was also associated with higher adenoma detection. Digital resources may help patients through the bowel preparation process and ultimately encourage more patients to participate in CRC screening.” – by Alex Young
Disclosure: One author reports involvement as medical advisor in software development of an APP prototype in 2013 (University of Applied Sciences, Munich, Germany). The other authors report no relevant financial disclosures.