Rates of colonoscopies boosted by text reminders, instructions

August 26, 2019

Having simple text conversations with patients one week before they are scheduled for a colonoscopy dramatically decreased the "no-show" rates, according to a recent study conducted by Penn Medicine researchers. Through sending reminders and instruction, opening the door for patients to ask questions, and sharing helpful links, the team increased rate of colonoscopies to 90 percent--well above the 62 percent success rate seen in a group who did not receive this extra communication. The results of this study were published in Health Education & Behavior.

"Automated text messaging and new insights from behavioral science offer opportunities to effectively and efficiently engage with patients before important health prevention activities," said the study's senior author, Shivan Mehta, MD, MBA, an assistant professor of Medicine and the associate chief innovation officer at Penn Medicine. "It's also important to keep in mind that these programs should be conducted in close partnership with clinical operations, and that we understand patient perspectives about these interventions."

In the United States, colorectal cancer is the second-deadliest form of cancer. Despite the danger presented by this disease, one in three people are not up-to-date on screening. As such, doctors like Mehta and the study's lead author, Nadim Mahmud, MD, MPH, a Hepatology fellow at the Hospital of the University of Pennsylvania, are exploring how technology and the framing of messages affect screening rates.

In April 2018, the researchers asked 22 patients scheduled for outpatient colonoscopy to participate in their text messaging program, featuring automation and two-way messaging powered by Penn Medicine's Way to Health platform. These 22 patients were compared to 50 patients in the control group who received the standard paper instructions and phone call reminder.

Examples of the automated messages patients were sent included: a congratulatory text and colonoscopy date reminder upon enrollment; a reminder with the office's address linked and a prompt for any questions about the procedure one-week before the appointment; a nudge to pick up prep materials (such as sports drinks and laxatives) from the pharmacy five days prior; and messages to prompt each step of the prep sequence the night before the appointment.

If patients responded with questions to any of the text prompts -- which three-quarters of them did -- the queries were escalated to gastroenterology staff, who answered within 24 hours.

"We think text messaging is successful because it is patient-centered. It is already widely used by our patient population, does not require much effort by the patient to participate, and patients can read or respond whenever they choose," said Mahmud. "Texting is also especially appealing to health systems because it is scalable and efficient - it's a tactic many others have employed in order to communicate with patients."

While the texting dramatically increased rates of success and was popular among the patients, the study showed that it didn't actually change the quality of prep among patients compared to those who just got a reminder call and paper instructions. This aspect of the program will likely be examined somewhat closer in the next phase of this study, which is being conducted currently with roughly 750 patients.

"We are evaluating the effectiveness of this service among a broader population and, in this new trial, we are automating some aspects of recruitment and engagement so that it will be easier to scale to routine operations across multiple endoscopy clinics," Mehta explained.
Sahil D. Doshi, BA; Mary S. Coniglio, MBA; Michelle Clermont, MD; Donna Bernard, MSN; Catherine Reitz, MPH; Vandana Khungar, MD, MSc; David A. Asch, MD, MBA

This study was supported in part by the National Center for Advancing Translational Science (grant number UL1TR001878) and also in part by the Institute for Translational Medicine and Therapeutics (ITMAT) at the University of Pennsylvania.

University of Pennsylvania School of Medicine

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