Patient compliance and suboptimal bowel preparation with split-dose bowel regimen in average-risk screening colonoscopy
Stacy B Menees, H Myra Kim, Patricia Wren, Brian J Zikmund-Fisher, Grace H Elta, Stephanie Foster, Sheryl Korsnes, Brittany Graustein, Philip Schoenfeld, Stacy B Menees, H Myra Kim, Patricia Wren, Brian J Zikmund-Fisher, Grace H Elta, Stephanie Foster, Sheryl Korsnes, Brittany Graustein, Philip Schoenfeld
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.
Objectives: 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.
Design: Prospective survey cohort.
Setting: Tertiary care setting.
Patients: Average-risk patients undergoing colonoscopy for colorectal cancer screening between August 2011 and January 2013.
Main outcome measurements: 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.
Limitations: 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.
Published by Mosby, Inc.
Source: PubMed