Automated Navigation to Improve Outpatient Colonoscopy Adherence
Condition: Adherence, Patient; Colonoscopy; Text Messaging
Study type: Interventional

Summary: 
      Outpatient colonoscopy adherence is negatively impacted by poor communication and challenges
      with bowel preparation. We plan to perform a randomized controlled trial at the Pennsylvania
      Presbyterian Medical Center to (1) provide text message-based educational and reminder
      messages to patients regarding a scheduled colonoscopy, and (2) evaluate the impact of the
      texting intervention on colonoscopy show rate and bowel preparation.
    

Detailed description: 
      Colorectal cancer (CRC) is the second leading cause of cancer death in the US, yet there are
      effective screening and treatment strategies that allow for early detection and treatment.
      CRC screening is recommended for all individuals aged 50-75, which could include stool
      testing or colonoscopy, but national rates are still suboptimal at 59-65%. Colonoscopy is an
      essential component of CRC screening, as it is also required if stool testing is positive.
      However, colonoscopy requires a complex process to identify an escort, purchase the
      preparation, take a day off from work, adhere to a clear liquid diet, and complete the
      split-dose preparation as recommended. This results in a significant no-show and cancellation
      rate, along with suboptimal preparation quality, which can lead to non-adherence and
      incomplete screening.

      Current approaches to engaging patients include having nurses call patients before the
      procedure or patient navigators. However, it is often difficult to get patients on the phone,
      and these interventions can be costly, making it less scalable for clinical practices. Other
      interventions such as videos or mobile apps have been limited by poor user experience or
      limited engagement with the patient. There is an opportunity to leverage an automated text
      message navigation intervention using the Way to Health (WTH) platform to improve patient
      engagement prior to colonoscopy completion. The WTH platform is a Penn Medicine platform that
      is hosted on site at the University of Pennsylvania. The platform allows custom text messages
      to automatically be sent to patients, in addition to bidirectional message capabilities. WTH
      is protected by a secure firewall and is a HIPAA compliant platform.

      In the past year, our team conducted a quality improvement pilot initiative using WTH that
      tested the feasibility and impact of a one-week text messaging protocol for patients who were
      scheduled for outpatient colonoscopy. The text messages sent to patients contained
      information about the preparation process and instructions, expectations about the procedure,
      and reminders about location and timing. Among the 21 patients enrolled in the pilot, we
      found high user acceptability and higher colonoscopy show rates as compared to baseline
      values at Pennsylvania Presbyterian Medical Center. As such we believe that the texting
      intervention is feasible for testing in the context of a randomized controlled trial.
    

Intervention name(s): Text Message-based Intervention
Intervention type(s): Behavioral
Intervention description(s): The intervention consists of a series of educational and reminder text messages that a patient will receive in the week prior to a scheduled colonoscopy, in addition to two text messages at the time of enrollment explaining the texting program.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Health Services Research