Adherence, Patient, Colonoscopy, Text Messaging
Conditions
Brief summary
Outpatient colonoscopy adherence is negatively impacted by poor communication and challenges with bowel preparation. We plan to perform a randomized controlled trial at the Pennsylvania Presbyterian Medical Center to (1) provide text message-based educational and reminder messages to patients regarding a scheduled colonoscopy, and (2) evaluate the impact of the texting intervention on colonoscopy show rate and bowel preparation.
Detailed description
Colorectal cancer (CRC) is the second leading cause of cancer death in the US, yet there are effective screening and treatment strategies that allow for early detection and treatment. CRC screening is recommended for all individuals aged 50-75, which could include stool testing or colonoscopy, but national rates are still suboptimal at 59-65%. Colonoscopy is an essential component of CRC screening, as it is also required if stool testing is positive. However, colonoscopy requires a complex process to identify an escort, purchase the preparation, take a day off from work, adhere to a clear liquid diet, and complete the split-dose preparation as recommended. This results in a significant no-show and cancellation rate, along with suboptimal preparation quality, which can lead to non-adherence and incomplete screening. Current approaches to engaging patients include having nurses call patients before the procedure or patient navigators. However, it is often difficult to get patients on the phone, and these interventions can be costly, making it less scalable for clinical practices. Other interventions such as videos or mobile apps have been limited by poor user experience or limited engagement with the patient. There is an opportunity to leverage an automated text message navigation intervention using the Way to Health (WTH) platform to improve patient engagement prior to colonoscopy completion. The WTH platform is a Penn Medicine platform that is hosted on site at the University of Pennsylvania. The platform allows custom text messages to automatically be sent to patients, in addition to bidirectional message capabilities. WTH is protected by a secure firewall and is a HIPAA compliant platform. In the past year, our team conducted a quality improvement pilot initiative using WTH that tested the feasibility and impact of a one-week text messaging protocol for patients who were scheduled for outpatient colonoscopy. The text messages sent to patients contained information about the preparation process and instructions, expectations about the procedure, and reminders about location and timing. Among the 21 patients enrolled in the pilot, we found high user acceptability and higher colonoscopy show rates as compared to baseline values at Pennsylvania Presbyterian Medical Center. As such we believe that the texting intervention is feasible for testing in the context of a randomized controlled trial.
Interventions
BEHAVIORALText Message-based Intervention
The intervention consists of a series of educational and reminder text messages that a patient will receive in the week prior to a scheduled colonoscopy, in addition to two text messages at the time of enrollment explaining the texting program.
Sponsors
University of Pennsylvania
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
TRIPLE (Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Scheduled for outpatient colonoscopy at Pennsylvania Presbyterian Medical Center * Subject has a cell phone with enabled text messaging capability
Exclusion criteria
* Fewer than 14 days between the time of enrollment and time of scheduled colonoscopy * Subject is non-English speaking requiring a translator * Subject is not the primary individual receiving the text messages
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Colonoscopy show rate with good or excellent bowel prep | Assessed on day of colonoscopy | The proportion of patients who show up to their scheduled colonoscopy appointment and have a good or excellent prep |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Bowel preparation quality | Assessed on day of originally-scheduled colonoscopy | The grading of bowel preparation quality (poor, fair, adequate, good, excellent) among those patients who show to their scheduled colonoscopy |
| Colonoscopy cancellation rate | Assessed on day of originally-scheduled colonoscopy | The proportion of patients who cancel their originally scheduled colonoscopy appointment |
| Colonoscopy show rate | Assessed on day of colonoscopy | The proportion of patients who show up to their scheduled colonoscopy appointment |
| Colonoscopy no-show rate | Assessed on day of originally-scheduled colonoscopy | The proportion of patients who do not show for their scheduled colonoscopy appointment and who have not canceled |
| Timing of advance cancellation notification (in days) | Assessed on day of originally-scheduled colonoscopy | The number of days in advance that a patient cancels their scheduled colonoscopy |
| Colonoscopy reschedule rate | Assessed on day of originally-scheduled colonoscopy | The proportion of patients who cancel and reschedule (for a future date) on the same day, at least one day prior to the originally scheduled colonoscopy appointment date |
Countries
United States
Outcome results
None listed