Randomized Controlled Trial Demonstrates a Web-based Multimedia Program Used Prior to First-Time Colonoscopy Decreased Patient Anxiety, Sedation Requirement, and Procedure Time While Increasing Knowledge

Abstract

Purpose: Colonoscopy for colorectal cancer screening is an elective and voluntary medical procedure with participation, quality, and success dependent in part on patient understanding and cooperation. We explored the impact of a web-based multimedia patient engagement program on patient anxiety, perception, and knowledge about the colonoscopy in addition to procedure outcomes. Methods: We conducted a randomized controlled trial comparing a control group that received our institution's standard pre-procedure colonoscopy packet with an experimental group that watched a web-based multimedia patient engagement program (Emmi Solutions) in addition to receiving the same pre-procedure packet. All patients over age 18 scheduled for first-time colonoscopy on an elective outpatient basis were eligible. Patients were required to have watched the educational program prior to their scheduled procedure in order to participate in the experimental arm. On the day of colonoscopy, participants in both groups were asked to fill out the same survey prior to their procedure. The survey included questions to assess demographics and knowledge of colonoscopy, in addition to the State Trait Anxiety Inventory (STAI), a validated assessment of anxiety. We also collected procedure specific data including conscious sedation medication doses, quality of prep, and cecal/ileal intubation rates. Statistical comparisons were performed using the Mann-Whitney U and Fisher's exact test. Results: The control (n=51) and experimental (n=52) groups were demographically similar with the exception that a greater proportion of the experimental group had a graduate degree (p<0.005). More than half (58%) of patients in the experimental group reported that the intervention reduced their anxiety about the procedure. The STAI score was significantly lower in the experimental group compared to the control group (35.4 vs 40.4, p=0.026). Patients in the experimental group correctly answered the knowledge questions more often than the control group (82% vs 74% correct, p<0.001). There was no statistical difference in the rate of cecal or ileal intubation or the quality of preparation. Patients who viewed the web-based program required less midazolam on average (3.66 mg vs 4.46 mg, p=0.0035) and procedures were overall shorter (24.8 vs 29 minutes, p=0.024). Conclusion: A web-based multimedia patient engagement program watched prior to colonoscopy significantly decreased patient anxiety, sedation medication requirements, and procedure time while increasing knowledge. This easy intervention could not only help patients understand and feel more comfortable about colonoscopy, but increase efficiency and decrease cost by saving time and using lower doses of sedative medications. Disclosure - Dr. Siegel - Advisor: Emmi Solutions, LLC.