Colonoscopy Clinical Trial
Official title:
Automated Text Message Navigation to Improve Outpatient Colonoscopy Show Rate and Bowel Preparation
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.
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.
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