Assessing the effectiveness of telephoning positive FOBT patients prior to their colonoscopy on quality of the bowel preparation: a randomized controlled trial
Introduction: A good bowel preparation is critical for a successful high-quality colonoscopy. The consequences of poor bowel preparation include missed lesions and the need for a repeat colonoscopy at additional cost to the health care system. Factors affecting the quality of bowel preparation include patient factors (age, sex, comorbidity, language barrier) and type of bowel preparation.
Aim: We conducted a double blind randomized controlled trial to assess the effectiveness of a dedicated endoscopy nurse telephoning patients 3 days before their colonoscopy on the quality of bowel preparation assessed using the Boston Bowel Prep Score (BBPS). Secondary measures included patient satisfaction and the type of frequently asked questions during the intervention.
Methods: Participants were prospectively recruited from gastroenterology outpatient clinics based on positive FOBT test results. After obtaining written informed consent, participants were stratified by sex and randomized into 1:1 intervention or control cohorts. A calibration training session on the use of BBPS with all proceduralists took place prior to the study in order to standardize scoring. Inadequate bowel preparation requiring a repeat colonoscopy is indicated by any BBPS sub-score ≤1 out of 3 or a total score ≤ 5 out of 9. Basic demographic details, previous colonoscopy experience, language background, assistance at home, endoscopy location, and timing of the endoscopy session were recorded. The result was analyzed descriptively. The study was approved by the relevant Human Research Ethics Committee and funded by the NSW Cancer Institute.
Results: Of 345 eligible patients, 305 were randomized - 141 control and 138 treatment patients who completed the study. Poor bowel preparation requiring a repeat colonoscopy was noted in 9.2% of the control group and 8.7% of the treatment group, a non-significant result (P > 0.05). Interestingly, better bowel preparation was noted in the colonoscopy naïve participants (8.5% v 15.2%) and those in the afternoon session (5.9% vs 11.9%). No statistical significance in bowel preparation quality was found between the variables age, sex, country of birth, language at home, use of interpreter and assistance at home.
Conclusions: Having a dedicated nurse telephoning the participants 3 days prior to their colonoscopy to clarify any bowel preparation questions did not significantly reduce the proportion of positive FOBT patients with inadequate preparation.