Authors (including presenting author) :
Ng CKM, Wu EST, Yong JXE, Li RST
Affiliation :
Department of Medicine and Geriatrics, Princess Margaret Hospital
Introduction :
Diagnostic accuracy of colonoscopy depends on the quality of bowel preparation. Poor bowel preparation results in longer procedural time, lower adenoma detection rates, shorter surveillance intervals and higher chance of missing cancerous lesions. Education programs administered by health care professionals enhance patient compliance, improve quality, and decrease repeat examinations and costs. This patient navigator helps guide patients through colonoscopy, providing education and appointment reminders, and reviewing bowel preparation protocol close to the procedure date.
Objectives :
To evaluate the quality of bowel preparation after patient education administered by a designated patient navigator, and assess patients’ satisfaction on colonoscopy experience.
Methodology :
This prospective single-blind randomised study included 100 patients with their first colonoscopies. 50 patients each were randomised into two arms: New Care Pathway, and Conventional Care Pathway. In the New Care Pathway, patients were interviewed and educated by a designated nurse navigator within two weeks of appointments, and watched an animated video on the importance of bowel preparation. In the Conventional Care Pathway, patients were provided with written instruction and directed to a nursing station for appointment booking and bowel preparation teaching, then received a phone call reminder on appointment, medication management and bowel preparation two weeks before colonoscopy. Boston Bowel Preparation Scale (BBPS) (0 to 9) was used to assess quality of bowel preparation. A five-point scale was used to assess patients’ satisfaction on the explanation of pre-examination preparation and colonoscopy.
Result & Outcome :
Patients in the New Care Pathway (n=50) had higher total BBPS scores than those in the Conventional Care Pathway (n=50) (8.34 vs. 8.22, difference=0.12, P=0.595). The same trend was observed in patients with education level of primary school or above (n=90) (8.41 vs. 8.30, difference=0.11, P=0.649), and in illiterate patients (n=10) (7.83 vs. 7.25, difference=0.58, P=0.508). Improvement on BBPS was better in illiterate patients than educated patients (0.58 vs. 0.11). In both pathways, 100% of patients were satisfied with the explanation of pre-examination preparation and colonoscopy, having a grading of satisfactory or above. In conclusion, a designed patient navigator may improve the quality of bowel preparation for colonoscopy, especially in illiterate patients, and provide satisfactory patients’ experience in the explanation of colonoscopy preparation and procedure. Future large studies are needed to confirm the potential findings of this colonoscopy navigator study.
