Impact Of Different Educational Ways On Inpatients Bowel Preparation Quality For Colonoscopy

BackgroundColorectal cancer is one of the most common malignancies in the world.Colorectal cancer(CRC)is the second leading cause of cancer-related deaths in the United State.In China,colorectal cancer is one serious threat to the lives and health of people.Its' incidence and mortality are the third and fourth of malignant tumors respectively.Colonoscopy can prevent CRC by the detection and removal of precancerous lesions.In addition,its' incidence increases quickly in most areas.Electronic colonoscopy is one of the primary means of diagnosing and treating colorectal diseases and is considered to be the gold standard for colorectal lesions.Good bowel preparation is a prerequisite for successful colonoscopy and treatment.Although the current common bowel preparation method can basically meet the needs,there are still about 20%patients who cannot receive the good results of colonoscopy due to halfway intestinal preparation.It is reported that the bowel preparation is not complete because of the complex preparation process and the patient's poor compliance.We should strengthen patient's learning ability and strict compliance for intestinal preparation so as to improve the quality of intestinal cleaning.At present,the way of the clinical bowel preparation education has some defects such as the description mode,the ease of understanding,the application scope and so on.We assume that the compliance of patients and the quality of bowel preparation can be improved by using cartoon education chart to explain the process,method,importance and matters.ObjectiveThe purpose of this study is to evaluate the quality impact of patient education by using cartoon pictures on bowel preparation,and further to explore the clinical value of cartoon educational pictures.MethodsThis study was a prospective,randomized controlled study.Two hundred patients were enrolled in the Department of Gastroenterology,Shandong Provincial Hospital from May to November in 2016.1.Inclusion criteriaThe patients enrolled in this study were aged between 20 and 65 years old.It's required that they can read and understand the instructions and be able to sign informed consent for digestive endoscopy(see Appendix 1).2.Exclusion criteria(1)Patients with a history of colorectal surgery;(2)Patients with severe intestinal stenosis,obstruction,or a high degree of suspected stenosis and obstruction;(3)Patients with dysphagia;(4)Patients with severe diabetic gastroparesis or stomach outflow tract obstruction;(5)Highly suspected to be perforated or have perforated patients;(6)Patients with severe renal insufficiency or end-stage renal disease;(7)Patients with severe arrhythmia,unstable angina,acute myocardial infarction,or severe heart failure(New York Heart Association,NYHA grade 3 or 4 patients);(8)Severe hypertensive patients(systolic blood pressure higher than 170mmHg,or diastolic blood pressure higher than 100mmHg),patients with poor blood pressure control and secondary hypertension without treatment of primary disease;(9)Patients with suspicious suffering from toxic Hirsch sprung disease;(10)Patients with disorders electrolyte;(11)Patients with severe dehydration but not yet fully rehydration;(12)Pregnant or lactating women;(13)Patients with no self-care ability,poor cognitive ability,or not understand the digestive endoscopy informed consent;(14)Acute gastrointestinal bleeding hemodynamics and life Signs of unstable patients;(15)Patients suffering from weak color;(16)Patients with coagulation disorders caused by various causes,such as hemophiliacs;(17)Patients disagreed to be involved in the study.After signing the informed consent of digestive endoscopy,patients were randomized into two groups by using a random-number generator,one was cartoon education group which was the experimental group,and the other was conventional education group which was the control group.After the two groups both received oral education on bowel preparation,patients in the conventional education group received a written instruction,and patients in the cartoon education group received an educational cartoon picture.All patients were told that they could not leak their preparation guidelines to the colonoscopists and other staff in the endoscopy room either before or after the procedure.3.Education and bowel preparationAll patients will be informed of the preparation procedure,importance,how to prepare and take the bowel cleanser as well as the possible symptoms and countermeasures.The gastrointestinal preparations used in the digestive ward of Shandong Provincial Hospital are Polyethylene Glycol Electrolyte Powder(PEG-ELP).In this study,half of the recommended dose was taken on the day before colonoscopy,and the second dose should be administered between 4 to 6 hours before the planned start of the colonoscopy procedure.The bowel preparation method of this study is that all patients were told to eat a low-residue diet on the day before colonoscopy;They should eat liquid dinner at 17:00.2L polyethylene glycol electrolyte solution was prepared at 18:00.The preparation method is as follows:1 bag of powder and 2 liters of warm water were mixed and divided into 8 cups,250ml per cup,drink a cup every 15 minutes and drink all within two hours.At 5 a.m.of the check day,another 2L polyethylene glycol electrolyte was prepared and drunk in the same manner as described above.After the bowel preparation,all patients received colonoscopy at 9 a.m.to 11 a.m.4.Data collectionBefore colonoscopy,nurses collected the basic information such as sex and age of selected patients.Colonoscopy was performed by five senior endoscopy physicians in the digestive endoscopic center.Each endoscopic physician has done at least one thousand colonoscopies.All colonoscopies were performed using the OLYMPUS-CV260 endoscope.After colonoscopy or treatment,endoscopy physician recorded the quality of the patient's intestinal cleansing according to the intestinal preparation evaluation scale.The numerical variables are expressed as the mean ? standard deviation(SD).The Student t test was used to make comparisons.Comparisons among multiple groups were made using ANOVA.The ?2 test or Fisher's exact test was used to analyze frequencies.Statistical significance was defined by P<0.05.Results1.Two hundred patients were enrolled in this study,one hundred in cartoon education group and one hundred in conventional written instruction group.There is no statistical difference in the baseline characteristics,constituent of colonoscopy history and family history of colon cancer between these two groups.2.The Aronchick Scale was used to evaluate the bowel preparation of the two groups.The excellent percentage of patients in the cartoon education group(60/100)is significantly higher than the conventional education group(45/100).The difference is statistically significant(P<0.05).3.Intensive bowel preparation was evaluated using the Ottawa Bowel Preparation Scale(OBPS).We found that the average scores of the left and right colon,total colon and fluid residual in the cartoon education group are lower than those in the conventional education group respectively.The difference is statistically significant(all P values were less than 0.05).The total score of the cartoon education group is lower than that of the conventional education group,and the difference is statistically significant(P<0.01).4.The Harefield Cleaning Scale(HCS)was used to evaluate the intestinal cleansing of the two groups.The proportion of the "A" rating(61/100)of the cartoon education group is significantly higher than that of the conventional education group?(46/100).The difference is statistically significant(P<0.05).The ratio of "C" rating(4/100)of the cartoon education group is significantly lower than that of the conventional education group(19/100),and the difference is statistically significant(P<0.01).5.The Boston Bowel Preparation Scale(BBPS)was used to evaluate the bowel preparation of the two groups.The proportion of the "excellent" rating(80/100)of the cartoon education group is significantly higher than that of the conventional education group(63/100).The difference is statistically significant(P<0.01).The proportion of patients(20/100)who received "poor" evaluation in the cartoon education group is significantly lower than that in the conventional education group(34/100).The difference is statistically significant(P<0.05).6.The Chicago Bowel Preparation Scale(CBPS)was used to evaluate the bowel preparation of the two groups.The proportion of patients(27/100)in the cartoon education group who achieved "bowel preparation best" is significantly higher than in the conventional education group(8/100),and the difference is statistically significant(P<0.001).The proportion of patients(10/100)in the cartoon education group who achieved "intestine insufficiency" is significantly lower than that in the conventional education group(22/100),and the difference is statistically significant(P<0.05).ConclusionCompared with conventional written instruction,educational cartoons can significantly improve the quality of bowel preparation for colonoscopy.Patient education in the bowel preparation process is valid and very important;It is a low cost without the risk of intervention,so it is worthy of clinical promotion.