title: How Efficacious Are Patient Education Interventions to Improve Bowel Preparation for Colonoscopy? A Systematic Review.
abstract: BACKGROUND
  Bowel preparation is inadequate in a large proportion of colonoscopies, leading to multiple clinical and economic harms. While most patients receive some form of education before colonoscopy, there is no consensus on the best approach.
  
  
  OBJECTIVE
  This systematic review aimed to evaluate the efficacy of patient education interventions to improve bowel preparation.
  
  
  METHODS
  We searched the Cochrane Database, CINAHL, EMBASE, Ovid, and Web of Science. Inclusion criteria were: (1) a patient education intervention; (2) a primary aim of improving bowel preparation; (3) a validated bowel preparation scale; (4) a prospective design; (5) a concurrent control group; and, (6) adult participants. Study validity was assessed using a modified Downs and Black scale.
  
  
  RESULTS
  1,080 abstracts were screened. Seven full text studies met inclusion criteria, including 2,660 patients. These studies evaluated multiple delivery platforms, including paper-based interventions (three studies), videos (two studies), re-education telephone calls the day before colonoscopy (one study), and in-person education by physicians (one study). Bowel preparation significantly improved with the intervention in all but one study. All but one study were done in a single center. Validity scores ranged from 13 to 24 (maximum 27). Four of five abstracts and research letters that met inclusion criteria also showed improvements in bowel preparation. Statistical and clinical heterogeneity precluded meta-analysis.
  
  
  CONCLUSIONS
  Compared to usual care, patient education interventions appear efficacious in improving the quality of bowel preparation. However, because of the small scale of the studies and individualized nature of the interventions, results of these studies may not be generalizable to other settings. Healthcare practices should consider systematically evaluating their current bowel preparation education methods before undertaking new interventions.
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, United States of America.|Veterans Affairs Ann Arbor Health Care System, 2215 Fuller Rd, Ann Arbor, MI, 48105, United States of America.
authors.forename: Jacob E
authors.initials: JE
authors.lastname: Kurlander
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, United States of America.
authors.forename: Arjun R
authors.initials: AR
authors.lastname: Sondhi
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, United States of America.|Veterans Affairs Center for Clinical Management Research, 2215 Fuller Rd, Ann Arbor, 48105, MI, United States of America.
authors.forename: Akbar K
authors.initials: AK
authors.lastname: Waljee
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, United States of America.|Veterans Affairs Ann Arbor Health Care System, 2215 Fuller Rd, Ann Arbor, MI, 48105, United States of America.
authors.forename: Stacy B
authors.initials: SB
authors.lastname: Menees
authors.affiliation: Department of Health Behavior and Health Education, University of Michigan School of Public Health, 3790 SPH I, 1415 Washington Heights, Ann Arbor, MI, 48109, United States of America.
authors.forename: Cathleen M
authors.initials: CM
authors.lastname: Connell
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, United States of America.|Veterans Affairs Center for Clinical Management Research, 2215 Fuller Rd, Ann Arbor, 48105, MI, United States of America.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Schoenfeld
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, United States of America.|Veterans Affairs Center for Clinical Management Research, 2215 Fuller Rd, Ann Arbor, 48105, MI, United States of America.
authors.forename: Sameer D
authors.initials: SD
authors.lastname: Saini
mesh_terms: D003108:Colonic Diseases / Q000175:diagnosis; D003111:Colonic Polyps / Q000175:diagnosis; D003113:Colonoscopy; D016208:Databases, Factual; D006801:Humans; D010353:Patient Education as Topic