Comparative Effectiveness of Enhanced Patient Instructions for Bowel Preparation Before Colonoscopy: Network Meta-analysis of 23 Randomized Controlled Trials.

Xu Tian,Li-Juan Yi,Yang Han,Xiao-Ling Liu,Hui Chen,Wei-Qing Chen,Maria F Jiménez-Herrera

doi:10.2196/19915

Abstract

BackgroundVarious enhanced patient instructions (EPIs) have been used for bowel preparation (BP) and our previous meta-analysis also demonstrated the efficacy of EPIs in increasing the colonic polyp and adenoma detection rates; however, the optimal method for adequate BP has not yet been developed.ObjectiveWe performed a network meta-analysis to determine the optimal instructions.MethodsWe searched for randomized controlled trials (RCTs) comparing the effectiveness of EPIs with each other or standard patient instructions (SPIs) for BP. We performed direct and Bayesian network meta-analyses for all instructions and used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria to appraise the quality of evidence.ResultsWe included 23 RCTs (7969 patients) comparing 10 different instructions. In direct meta-analyses, most of the EPIs, except visual aids and mobile apps, increased the adequate preparation rate (APR). Network meta-analyses showed that additional explanations were superior to visual aids (odds ratio [OR] 0.35, 95% CI 0.19-0.59), telephone calls (OR 0.62, 95% CI 0.37-0.99), educational videos (OR 0.79, 95% CI 0.5-0.77), and mobile apps (OR 0.33, 95% CI 0.14-0.68) with low-to-high-quality evidence; newly designed booklets (OR 3.28, 95% CI 1.59-6.16), SMS text messaging (OR 2.33, 95% CI 1.28-3.91), telephone calls (OR 1.86, 95% CI 1.03-1.78), educational videos (OR 2.33, 95% CI 1.40-3.65), and social media applications (OR 2.42, 95% CI 1.4-3.93) were superior to visual aids and mobile apps with low-to-high-quality evidence. SMS text messaging, telephone calls, and social media applications increase adherence to and satisfaction with the BP regime. Social media applications reduce the risk of adverse events (AEs). Telephone calls and social media applications increase the polyp detection rate (PDR).ConclusionsNewly designed booklets, telephone calls, educational videos, and social media applications can improve the quality of BP. Telephone calls and social media applications improve adherence to and satisfaction with the BP regime, reduce the risk of AEs, and increase the PDR.Trial RegistrationINPLASY (International Platform of Registered Systematic Review and Meta-analysis Protocols) INPLASY2020120103; https://inplasy.com/inplasy-2020-12-0103/

Highlights

MethodsColorectal cancer ranks third among the most common cancers and second in terms of the incidence and cause of cancer-related mortality worldwide, with 1.8 million new cases and 0.88 million deaths in 2018 [1]
The analysis demonstrated that besides educational videos, SMS text messaging, telephone calls, and social media applications indicated satisfaction with the bowel preparation (BP) regime when compared to standard patient instructions (SPIs)
(2) Based on high-to-moderate-quality evidence, additional explanations offer significant advantages over visual aids, telephone calls, and educational videos, but not SMS text messaging and social media applications; additional explanations are superior to mobile apps but not to newly designed booklets and new visual aids, the quality of evidence ranges from low to very low

Summary

Introduction

MethodsColorectal cancer ranks third among the most common cancers and second in terms of the incidence and cause of cancer-related mortality worldwide, with 1.8 million new cases and 0.88 million deaths in 2018 [1]. It is discouraging that inadequate BP is associated with decreased polyp detection rates (PDRs), increased risk of adverse events (AEs), prolonged working time, and increased medical expenditure [10,11]. Various enhanced patient instructions (EPIs) have been used for bowel preparation (BP) and our previous meta-analysis demonstrated the efficacy of EPIs in increasing the colonic polyp and adenoma detection rates; the optimal method for adequate BP has not yet been developed. SMS text messaging, telephone calls, and social media applications increase adherence to and satisfaction with the BP regime. Telephone calls and social media applications increase the polyp detection rate (PDR). Telephone calls and social media applications improve adherence to and satisfaction with the BP regime, reduce the risk of AEs, and increase the PDR. Trial Registration: INPLASY (International Platform of Registered Systematic Review and Meta-analysis Protocols) INPLASY2020120103; https://inplasy.com/inplasy-2020-12-0103/

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