Tu1360 Patient Activation, Not Health Literacy, Determines Bowel Preparation Quality for Colonoscopy

Should Bowel Preparation or Prokinetics Be Used Before Video Capsule Endoscopy ? a Systematic Review and Meta Analysis Vikram Kotwal*, Bashar M. Attar, Saurabh Gupta, Rajender Agarwal John H Stroger Jr Hospital of Cook County, Chicago, IL Background and Aims: Role of bowel preparation and prokinetics prior to small bowel video capsule endoscopy (VCE) is controversial. We performed a systematic review and meta-analysis to study the effect of purgatives, simethicone and prokinetics on the outcomes associated with VCE. Methods: We performed literature searches in MEDLINE and Cochrane Library and included randomized controlled trials studying the effect of purgatives, simethicone or prokinetics in patients undergoing VCE. Our outcomes of interest were visualization quality, diagnostic yield and completion rate. Results: When compared to overnight fasting, bowel preparation with polyethylene glycol (PEG) led to adequate visualization in significantly higher number of patients undergoing VCE [odds ratio (OR) 3.13 ( 95% confidence interval (CI) (1.70-5.75) ]. Both PEG and sodium phosphate significantly improved diagnostic yield [OR 1.68 (95% CI 1.16-2.42), and OR 1.77 (95% CI 1.18-2.64), respectively] but had no significant effect on completion rate. However, there was significant heterogeneity among studies. All studies with simethicone, although underpowered showed significantly improved visualization quality with its use, without affecting completion rate. Prokinetics did not significantly improve the completion rate of VCE. Conclusions: Preparation with PEG, but not sodium phosphate, prior to small bowel VCE leads to improved visualization quality. Both PEG and sodium phosphate improve diagnostic yield of VCE without affecting completion rate, but results are driven by certain studies. Simethicone appears to improve visualization quality without affecting completion rate of VCE but its effect on diagnostic yield is uncertain. Prokinetics do not improve completion rate of VCE. More data are needed before recommendations regarding bowel preparation before VCE can be made. Tu1360 Patient Activation, Not Health Literacy, Determines Bowel Preparation Quality for Colonoscopy Marina Serper*, Andrew J. Gawron, Allison R. Dahlke, Elizabeth a. Bojarski, Rajesh N. Keswani, Michael S. Wolf Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL; Health Literacy and Learning Program, Division of General Internal Medicine, Northwestern University, Chicago, IL Background: Colonoscopy is an effective screening modality for colorectal cancer but requires adequate bowel cleansing for polyp detection. Preparation quality depends on a patient’s ability to follow specific pre-procedure instructions. While low health literacy has been linked to poor understanding of hypothetical colonoscopy instructions, its relationship to actual bowel preparation quality in clinical practice is unclear. Furthermore, we hypothesized that patient activation may play an important role in determining bowel preparation quality and colonoscopy outcomes. Our objective was to examine the relationship between health literacy, patient activation, and colonoscopy outcomes. Methods: The study sample consisted of 462 adults undergoing outpatient colonoscopy aged 55 to 74 from an ongoing National Institute of Aging sponsored study: Health Literacy and Cognition in Older Adults. Two-day, structured interviews were conducted with patients to obtain demographics, health literacy measured by the Test of Functional Health Literacy in Adults(TOFHLA), and patient activation measured by the Patient Activation Measure short form (Figure 1). A chart review was performed to assess colonoscopy quality including: cecal intubation rate(CIR), adenoma detection rate(ADR), and bowel preparation quality. Baseline characteristics were calculated with descriptive statistics. Chi-squared tests and t-tests were used in bivariate analyses. Multivariable logistic regression was used to examine the association between health literacy, patient activation, and colonoscopy preparation quality controlling for relevant covariates. Results: Patients were predominantly female (70.1%), non-Hispanic white (65.1%), and college graduates (63.8%); mean age was 63.4 (5.4). Most (89.6%) underwent colonoscopy for screening or surveillance. Overall CIR was 97.6% and ADR was 26.8% (males 32.8%, females 24%, p 0.01). Preparation quality was suboptimal in 134 patients (32.5%), 79 of which had poor preparation (17.1% of total). A total of 76 patients (16.7%) had inadequate health literacy and 116 (25.1%) had low patient activation scores. (See Table 1 for bivariate analyses). After adjusting for age, gender, race, education, smoking, and comorbid conditions in multivariate analysis, diabetes (OR 2.79, CI 1.48-5.26) and low patient activation (OR 2.07, CI 1.27-3.40) were independent predictors of suboptimal bowel preparation quality while health literacy was not (OR 0.76, CI 0.37 1.56). Conclusions: Despite a high average education and health literacy level in this cohort, we noted significant rates of suboptimal bowel preparation quality. Low patient activation predicted suboptimal preparation quality suggesting that motivation may play an important role in colonoscopy preparation. Future interventions should target improving patient motivation in colon cancer screening.