Impact of a Novel Patient Educational Booklet on Colonoscopy Quality

Background: Achievement of colonoscopy outcomes depends on high-quality bowel preparation by
patients; yet inadequate preparation is common.

Objective: To develop and test an educational booklet to improve bowel preparation quality.

Design: "Before-and-after" study followed by randomized controlled trial.

Setting: Veteran Affairs medical center.

Patients: Patients undergoing outpatient colonoscopy

Measurements: The investigators first performed cognitive interviews to identify knowledge
and belief barriers to high-quality colonoscopy preparation. The investigators then created
a patient educational booklet addressing patient barriers to improve preparatory behaviors.
The investigators tested the booklet in 2 sequential studies: (1) controlled
"before-and-after" study in patients undergoing colonoscopy during 2 consecutive months: 1
without and 1 with the booklet; (2) randomized controlled trial. The outcome in both
studies was bowel preparation quality measured on a 6-point Likert scale (>5="good"). In
each study the investigators compared the proportion achieving a "good" preparation between
groups and performed logistic regression to measure the effect of the booklet on preparation
quality while adjusting for the purgative received.

Limitations: Unknown impact on polyp yield and cancer reduction.