Implementation of Standardized Patient Education to Improve Adherence with Colonoscopy for Colorectal Cancer Screening

BACKGROUND: Colorectal cancer (CRC) is the third leading cause of cancer deaths among men and women in the U.S. CRC is preventable and manageable when detected early. Approximately 30% of average-risk Americans are overdue for colonoscopy screening. Colonoscopy screenings can reduce death by 67%. Current evidence suggests CRC screening education improves screening uptake among men and women at average-risk age.

LOCAL PROBLEM: The setting of this practice improvement project was a private colorectal surgery practice in South Texas, serving primarily Hispanic/Latino and Caucasian patients. Cancellation rates before colonoscopy were 16.8%, and there was no standardized education for CRC screening colonoscopy consultations at the site. Recent studies and the American College of Gastroenterology recommended educational programs to improve colonoscopy completion. The purpose of the project was to standardize screening colonoscopy education for English and Spanish speakers with the aim of decreasing cancellation rates by 25%.

METHODS: The Evidence-based Practice Improvement (EBPI) model provided a framework for project implementation. The clinical workflow for administering the educational tool was determined through PDSA (Plan-Do-Study-Act) cycles. Pre- and post-implementation data were measured to evaluate change in cancellation rates and process compliance.

INTERVENTIONS: A video providing basic colonoscopy and colon prep education was developed in English and Spanish and administered to patients in their preferred language via tablet in the exam room while awaiting provider consultation.

RESULTS: The video was administered in 86% of consultations. Aggregate colonoscopy cancellation rates decreased by 44% post-implementation. Considering only the patients who viewed the video, the decrease in cancellation rates was even greater at 70%.

CONCLUSIONS: Implementing a standardized educational video for patients during screening colonoscopy consultation had a statistically and clinically significant impact on decreasing cancellation rates. Improved screening significantly impacts CRC prevention and early detection within a population. Sustainability plans include making the video readily available to patients with a QR code.

The educational video implemented in this evidence-based practice improvement project may be accessed via the following url:

https://www.youtube.com/watch?v=NY4LEXC0VBU