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Timing of colonoscopy, patient factors affect split-dose bowel prep compliance
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Patients were less likely to comply to a split-dose bowel preparation regimen before colonoscopy if they had an early morning procedure, long travel time, poor education level, or if they were women, according to results from a recent study.
“It is widely known that a split-dose preparation regimen has been associated with higher adenoma detection and improved colon cleansing, so that it is strongly recommended by guidelines for elective colonoscopy,” Franco Radaelli, MD, from the division of gastroenterology at Valduce Hospital in Italy, told Healio Gastroenterology. “Unexpectedly, the adoption of split-dose regimen remains suboptimal worldwide.”
Franco Radaelli
Radaelli and colleagues conducted a multicenter prospective study to determine the uptake of split-dose regimens in routine clinical practice, and to explore patient-related barriers to its uptake. They enrolled 1,447 outpatients undergoing colonoscopy (mean age, 59.2 years; 54.3% men) who were given written instructions on a 4L polyethylene glycol bowel preparation, and a choice between a split-dose and day-before regimen after receiving a leaflet that emphasized the superiority of a split-dose regimen on colonoscopy outcomes. Before the procedure, patient factors related to uptake was reported via a 20-item questionnaire.
“Study results show that, when offered to choose between a split-dose and a day-before regimen, nearly 40% of the study population refused to undergo a split-dose regimen despite receiving adequate written information on the benefits of such preparation schedule,” Radaelli said.
Overall, 61.7% of patients chose the split-dose regimen, and the researchers observed a linear correlation between the time of the appointment and uptake of the split-dose regimen (27.3% of patients at 8:00 am vs. 96% of patients at 2:00 pm; P < .001). Multivariate analysis showed inverse correlations between split-dose uptake and appointments before 10:00 am (OR = 0.14; 95% CI, 0.11-0.18), more than an hour travel time to the appointment (OR = 0.55; 95% CI, 0.38-0.79), low education level (OR = 0.72; 95% CI, 0.54-0.95) and female sex (OR = 0.74; 95% CI, 0.58-0.95).
“Moreover, primary care physicians and pharmacists had a negative influence on the choice of a split-dose regimen,” Radaelli said.
Patients who completed bowel prep were significantly more likely to repeat the split-dose regimen vs. the day-before regimen, and the split-dose group also had significantly better quality of sleep. The risk for travel interruption (2.4%) and fecal incontinence (1.2%) was slightly increased in the split-dose group.
“The study also confirmed that, at multivariate analysis, split-dose regimen was independently associated with a threefold higher probability of adequate colon cleansing and a 50% increase of polyp detection,” Radaelli said, with respective corresponding ORs of 3.34 (95% CI, 2.4-4.63) and 1.46 (95% CI, 1.11-1.92).
“The present study shows the existence of patient-related barriers against split-dose preparation regimen, which should be addressed by adopting policies directed to reorganize colonoscopy timetables and educational initiatives to improve either patients’ or health care providers’ [education],” Radaelli said. “Another more coercive approach might be represented by the no-choice offer of split-dose regimen for colonoscopy preparation, although the patient compliance to such strategy should be further evaluated.” – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.
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