title: Patient compliance and suboptimal bowel preparation with split-dose bowel regimen in average-risk screening colonoscopy.
abstract: BACKGROUND
  Although split-dose bowel regimen is recommended in colon cancer screening and surveillance guidelines, implementation in clinical practice has seemingly lagged because of concerns of patient compliance.
  
  
  OBJECTIVE
  To assess patient compliance with the split-dose bowel regimen and assess patient- and preparation process-related factors associated with compliance and bowel preparation adequacy.
  
  
  METHODS
  Prospective survey cohort.
  
  
  METHODS
  Tertiary care setting.
  
  
  METHODS
  Average-risk patients undergoing colonoscopy for colorectal cancer screening between August 2011 and January 2013.
  
  
  METHODS
  Split-dose bowel regimen patient-reported compliance and bowel preparation adequacy with the Boston Bowel Preparation Scale score.
  
  
  RESULTS
  Surveys and Boston Bowel Preparation Scale score data were completed in 462 participants; 15.4% were noncompliant with the split-dose bowel regimen, and suboptimal bowel preparation (score <5) was reported in 16% of all procedures. White (P = .009) and married (P = .01) subjects were least likely to be noncompliant, whereas Hispanic subjects and those who reported incomes of US$75,000 or less were most likely to be noncompliant (P = .004). Participants who were noncompliant with split-dosing were less likely to follow the other laxative instructions and more likely to have their colonoscopy appointment before 10:30 am. Compliance differed by bowel preparation type (P = .003, χ(2) test), with those who used MiraLAX showing the highest compliance, followed by polyethylene glycol electrolyte solution and other bowel preparations. Noncompliance with split-dose bowel preparation (odds ratio 6.7; 95% confidence interval, 3.2-14.2) was the strongest predictor of suboptimal bowel preparation.
  
  
  CONCLUSIONS
  Patient self-report, performed at tertiary care center.
  
  
  CONCLUSIONS
  Overall, 1 in 7 patients do not comply with a split-dose bowel regimen. Ensuring compliance with the split-dose bowel regimen will reduce the risk of a suboptimal bowel preparation.
authors.affiliation: Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Stacy B
authors.initials: SB
authors.lastname: Menees
authors.affiliation: Division of Gastroenterology, Ann Arbor Veterans Administration Hospital, Ann Arbor, Michigan, USA.
authors.forename: H Myra
authors.initials: HM
authors.lastname: Kim
authors.affiliation: School of Health Sciences, Oakland University, Rochester, Michigan, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Wren
authors.affiliation: Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Zikmund-Fisher
authors.affiliation: Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Grace H
authors.initials: GH
authors.lastname: Elta
authors.affiliation: Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Foster
authors.affiliation: Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Korsnes
authors.affiliation: Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Brittany
authors.initials: B
authors.lastname: Graustein
authors.affiliation: Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA; Division of Gastroenterology, Ann Arbor Veterans Administration Hospital, Ann Arbor, Michigan, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Schoenfeld
mesh_terms: D002400:Cathartics / Q000008:administration & dosage*; D003113:Colonoscopy; D055088:Early Detection of Cancer; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D054368:Laxatives / Q000008:administration & dosage; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011446:Prospective Studies; D057566:Self Report; D013997:Time Factors; D044465:White People / Q000706:statistics & numerical data
chemical_list: D002400:Cathartics; D054368:Laxatives; D011092:Polyethylene Glycols