Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong; Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong; The Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong. Electronic address: https://twitter.com/ThomasYTLam.
Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong; Department of Gastroenterology and Hepatology, University of New South Wales, Sydney, Australia.
Int J Nurs Stud. 2022 Sep;133:104301. doi: 10.1016/j.ijnurstu.2022.104301. Epub 2022 May 30.
Adequate bowel preparation is an important colonoscopy quality indicator. Reinforced education is effective in improving bowel preparation quality of colonoscopy with mixed indications. However, it remains unclear whether such improvement can be consistently observed in pre- and post-irrigation during colonoscopy in screening population.
We aimed to study the effectiveness of nurse-led reinforced education delivered via mobile messenger (WhatsApp Messenger) on pre- and post-irrigation bowel preparation adequacy in colonoscopies for positive fecal immunochemical test in a population-based colorectal cancer screening program.
Randomized controlled trial.
A hospital-based endoscopy centre in Hong Kong, China.
Patients undergoing colonoscopy for positive fecal immunochemical test in a population-based colorectal cancer screening program.
The recruited patients were randomized to receive either WhatsApp Reinforced Education (WRE) or No Reinforced Education (NRE) (1:1). Patients in WRE group received one-off reinforced education of bowel preparation in text and video formats via WhatsApp Messenger four days prior to colonoscopy sent by investigator while NRE group received standard-of-care only. Primary outcome was the bowel preparation adequacy rate as evaluated by Aronchick Scale. Secondary outcomes included bowel preparation adequacy rate as evaluated by Boston Bowel Preparation Scale, adenoma detection rate and risk factors of bowel preparation inadequacy. Continuous variables were described as means with standard deviation (SD) and analyzed with Student's t-test. The Pearson Chi Square Test or Fisher Exact Test was used to assess categorical variables when appropriate. Risk factors were determined by logistic regression.
From July 2017 to April 2019, 685 eligible patients were randomized to WRE (n = 343) and NRE (n = 342) groups. Patients in WRE group had higher bowel preparation adequacy rate as evaluated by Aronchik Scale (83.4% vs 75.4%, p = 0.010) and Boston Bowel Preparation Scale (94.2% vs 88.9%, p = 0.013). Adenoma detection rate was higher in WRE group but without statistical significance (71.4% vs 67.5%, p = 0.27). In logistic regression, WhatsApp Reinforced Education reduced the inadequate bowel preparation risk (Adjusted odds ratio: 0.564; 95% confidence interval: 0.371-0.856, p = 0.007). Male gender (Adjusted odds ratio [AOR]: 1.638; 95% confidence interval [CI]: 1.054-2.546, p = 0.028) and diabetes (AOR: 2.062; 95% CI: 1.215-3.497, p = 0.007) were risk factors of bowel preparation inadequacy.
Nurse-led mobile messenger-initiated reinforced education improves both pre- and post-irrigation bowel preparation quality of screening colonoscopy following positive fecal immunochemical test. It is readily incorporable in clinical practice because of its low setup cost.
Registered on 4 July 2017 on https://clinicaltrials.gov/ (NCT03209739).
充分的肠道准备是结肠镜检查质量的一个重要指标。强化教育对于改善混合适应证结肠镜检查的肠道准备质量是有效的。然而，在筛查人群中，结肠镜检查前和后冲洗时，这种改善是否能够持续观察，目前尚不清楚。
我们旨在研究护士主导的基于移动消息（WhatsApp 消息）的强化教育对基于人群的结直肠癌筛查计划中阳性粪便免疫化学试验行结肠镜检查的前和后冲洗肠道准备充分性的影响。
随机对照试验。
中国香港一家医院内镜中心。
接受基于人群的结直肠癌筛查计划中阳性粪便免疫化学试验行结肠镜检查的患者。
招募的患者被随机分为 WhatsApp 强化教育（WRE）组或无强化教育（NRE）组（1:1）。WRE 组患者在结肠镜检查前 4 天通过研究者通过 WhatsApp 消息接收一次性肠道准备强化教育，包括文本和视频格式，而 NRE 组仅接受标准护理。主要结局是采用 Aronchick 量表评估的肠道准备充分率。次要结局包括采用波士顿肠道准备量表评估的肠道准备充分率、腺瘤检出率和肠道准备不充分的危险因素。连续变量以平均值和标准差（SD）表示，并采用学生 t 检验进行分析。适当情况下，采用 Pearson 卡方检验或 Fisher 确切检验评估分类变量。采用 logistic 回归确定危险因素。
2017 年 7 月至 2019 年 4 月，共有 685 名符合条件的患者被随机分配到 WRE（n=343）和 NRE（n=342）组。WRE 组采用 Aronchik 量表评估的肠道准备充分率（83.4% vs 75.4%，p=0.010）和波士顿肠道准备量表评估的肠道准备充分率（94.2% vs 88.9%，p=0.013）更高。WRE 组腺瘤检出率较高，但无统计学意义（71.4% vs 67.5%，p=0.27）。logistic 回归显示，WhatsApp 强化教育降低了肠道准备不充分的风险（调整后的优势比：0.564；95%置信区间：0.371-0.856，p=0.007）。男性（调整后的优势比[OR]：1.638；95%置信区间[CI]：1.054-2.546，p=0.028）和糖尿病（OR：2.062；95%CI：1.215-3.497，p=0.007）是肠道准备不充分的危险因素。
护士主导的基于移动消息的强化教育可改善阳性粪便免疫化学试验后筛查结肠镜检查的前和后冲洗肠道准备质量。由于其设置成本低，因此很容易纳入临床实践。
2017 年 7 月 4 日在 https://clinicaltrials.gov/（NCT03209739）注册。
