A Theory-Based Educational Booklet Improves Colonoscopy Attendance and Bowel Preparation Quality

Abstract

Introduction: Patients who “no-show” for colonoscopy or present with poor bowel preparation waste endoscopic resources and do not receive adequate examination for colorectal cancer (CRC) screening. At our VA hospital, which does not use open access endoscopy, the colonoscopy no-show rate is high and inadequate bowel preparation is a common occurrence. To address these issues, we designed a patient education booklet using health behavior theory and evaluated its effect on no-show rates and bowel preparation quality. Methods: We adapted the Health Belief Model for screening/surveillance colonoscopy and identified major targets for intervention. We then designed a 12-page color patient education booklet to target individual perceptions about CRC using simple facts, provide cues to action using graphics to explain the bowel preparation process, and increase likelihood of action by adopting a more palatable low residue diet (Fig 1). We compared the no-show rate over a two month period before and after introduction of the booklet, allowing for a wash-out period during which booklet use was inconsistent. We compared the Boston Bowel Prep Scale (BPPS) in 100 consecutive patients who underwent colonoscopy during each of the two periods.Figure: Select Sections of Patient Education Pamphlet.Results: Baseline characteristics between the two groups were similar, although patients who received the booklet were younger (Table). The no-show rate was significantly lower in patients who received the booklet than those who did not (13% vs. 21%, P=.01). The percentage of patients with adequate bowel prep—defined as BBPS>1 in all segments—increased from 82% to 86% after introduction of the booklet and surpassed the 85% metric recommended US Multi-Society Task Force, although the difference was not statistically significant (P=.44). The proportion of patients with BBPS=9 was significantly higher in the booklet group (Fig 2; 41% vs. 27%, P=.03). There was no difference in adenoma and sessile serrated adenoma detection rates before and after the booklet.Figure: Boston Bowel Preparation Scale Outcomes Before and After Patient Education Booklet.Table: Table. Patient Characteristics and OutcomesConclusion: Using a theory-based patient education intervention, we decreased our colonoscopy noshow rate by 38% and increased our adequate bowel preparation rate above the guideline-recommended 85%. Our adaptation of the Health Belief Model for screening/surveillance colonoscopy may be a useful construct for future health behavioral interventions.