Educational nurse-led telephone intervention shortly before colonoscopy as a salvage strategy after previous bowel preparation failure: a multicenter randomized trial

Marco Antonio Alvarez-Gonzalez, Miguel Ángel Pantaleón Sánchez, Belén Bernad Cabredo, Ana García-Rodríguez, Santiago Frago Larramona, Oscar Nogales, Pilar Díez Redondo, Ignasi Puig Del Castillo, Cristina Romero Mascarell, Noemí Caballero, Iván Romero Sánchez-Miguel, Rocío Pérez Berbegal, Domingo Hernández Negrín, Gema Bujedo Sadornill, Alicia Pérez Oltra, Gemma Casals Urquiza, Jaume Amorós Martínez, Agustín Seoane Urgorri, Inés Ana Ibáñez Zafón, Antonio Z Gimeno-García, Marco Antonio Alvarez-Gonzalez, Miguel Ángel Pantaleón Sánchez, Belén Bernad Cabredo, Ana García-Rodríguez, Santiago Frago Larramona, Oscar Nogales, Pilar Díez Redondo, Ignasi Puig Del Castillo, Cristina Romero Mascarell, Noemí Caballero, Iván Romero Sánchez-Miguel, Rocío Pérez Berbegal, Domingo Hernández Negrín, Gema Bujedo Sadornill, Alicia Pérez Oltra, Gemma Casals Urquiza, Jaume Amorós Martínez, Agustín Seoane Urgorri, Inés Ana Ibáñez Zafón, Antonio Z Gimeno-García

Abstract

Background: The most important predictor of unsuccessful bowel preparation is previous failure. For those patients with previous failure, we hypothesized that a nurse-led educational intervention by telephone shortly before the colonoscopy appointment could improve cleansing efficacy.

Methods: We performed a multicenter, endoscopist-blinded, randomized controlled trial. Consecutive outpatients with previous inadequate bowel preparation were enrolled. Both groups received the same standard bowel preparation protocol. The intervention group also received reinforced education by telephone within 48 hours before the colonoscopy. The primary outcome was effective bowel preparation according to the Boston Bowel Preparation Scale. Intention-to-treat (ITT) analysis included all randomized patients. Per-protocol analysis included patients who could be contacted by telephone and the control cases.

Results: 657 participants were recruited by 11 Spanish hospitals. In the ITT analysis, there was no significant difference between the intervention and control groups in the rate of successful bowel preparation (77.3 % vs. 72 %; P = 0.12). In the intervention group, 267 patients (82.9 %) were contacted by telephone. Per-protocol analysis revealed significantly improved bowel preparation in the intervention group (83.5 % vs. 72.0 %; P = 0.001).

Conclusion: Among all patients with previous inadequate bowel preparation, nurse-led telephone education did not result in a significant improvement in bowel cleansing. However, in the 83 % of patients who could be contacted, bowel preparation was substantially improved. Phone education may therefore be a useful tool for improving the quality of bowel preparation in those cases.

Trial registration: ClinicalTrials.gov NCT03567863.

Conflict of interest statement

Marco Antonio Álvarez-Gonzáles has received honoria from Norgine Ldt. for advisory board attendance, speaking and teaching and from Casen-Recordati for speaking and teaching.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Figures

Fig. 1
Fig. 1
Flow-chart of the study. ITT, intention to treat; PP, per protocol.

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Source: PubMed

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