Digitising colonoscopy care pathways and enhancing bowel preparation quality with patient reported measures (DIGICLEAN).

Participants in the interventional arm of the study will receive their bowel preparation instructions delivered via scheduled SMS, web-based smartphone application, email, and videos. All enrolled participants must possess a smartphone device. The interventional arm will occur in parallel design with the control arm. Depending on whether participants have a history of constipation, bloating, or diverticular disease as assessed by the faecal occult blood test (FOBT) nurse or the gastroenterologist at the initial phone call, participants will be stratified into one of two groups depending on their indicated bowel preparation regimens. Participants will be either given Standard Bowel Preparation instructions with PLENVU [macrogol 3350, sodium ascorbate, sodium sulfate anhydrous, ascorbic acid, sodium chloride, potassium chloride; polyethylene glycol containing ascorbic acid (PEG-ASC)], or Enhanced Bowel Preparation [PLENVU plus daily Movicol (sodium chloride, potassium chloride, bicarbonate, macrogol 3350) and Senokot (sennoside)]. Additional aperients, such as Movicol and Senokot, will be encouraged in the interventional arm through dynamic multimedia instructions if indicated. Participants will be asked to take PLENVU over a two-day split dosing schedule with the first 500 mL dose of PLENVU (including additional 500 mL of clear fluid) taken in the evening before the clinical procedure (at 6 pm) and the second 500 mL dose (including additional 500 mL of clear fluid) in the early morning of the day of the clinical procedure (at 5 am for morning procedure or 8 am for afternoon procedures). Participants in the Enhanced Bowel Preparation group will also take 1 sachet of Movicol and 2 Senokot tablets daily at 0800 in the week leading up to the colonoscopy. In the week leading up to the colonoscopy, depending on the bowel preparation group, regular SMS will be sent to the participant one to three times daily to remind participants regarding appropriate dietary and bowel preparation instructions (at 0800, 1700 and 2000). Scheduled SMS and messaging will also occur on the day prior to colonoscopy occurring at indicated times to consume bowel preparation. Daily assessment of dietary adherence and constipation, which involves completing a survey lasting for two to five minutes, will occur via the web-based smartphone application and depending on patient reported responses, dietary advice or alterations in bowel preparation will be given. The message delivery system will be monitored via a web interface by the FOBT nurse or the study nurse. A video explaining the procedure and the bowel preparation course will be sent to the participant via SMS and email at the time of enrolment and at 7 days before the colonoscopy, which can be re-accessed through a hyperlink. Participants will be asked to self-report their stool consistency and stool colour via the smartphone app after completion of their bowel preparation before the colonoscopy, and if unsatisfactory, may be advised to request a Fleet enema (sodium biphosphate and sodium phosphate) at time of arrival to the hospital. A Fleet enema is a laxative given via the rectum which causes bowel movements in around give minutes. After the colonoscopy, patient reported measures will be assessed. Additionally, depending on the site of the study, some participants will undergo their pre-anaesthetic assessment using the web-based application which will occur once at the time of enrolment.