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Few access Internet help for colonoscopy prep

By Andrew M. Seaman

NEW YORK (Reuters Health) - Despite reminders, people scheduled for a colonoscopy didn't access an Internet video designed to educate them about proper preparation for the screening, in a new study.

"We were really surprised. It wasn't just that nobody had Internet access… People just didn't want to go the extra step (and watch the video)," said Dr. Brian Jacobson, a gastroenterologist at Boston Medical Center.

Jacobson told Reuters Health that he and his colleagues had noticed between 7 and 10 percent of their patients were not properly preparing for a colonoscopy, such as by abstaining from eating and taking a laxative.

"The cleaner the colon the more likely we're to find polyps. By finding them, we remove them and thereby lower the risk of cancer," he said.

Previously, he and his colleagues had tried to encourage patients to follow the preparation instructions by sending postcard reminders with pictures of clean and dirty colons. But they didn't see a difference in compliance.

The government-backed U.S. Preventive Services Task Force recommends adults age 50 to 75 have a colonoscopy every 10 years to check for colon cancer, or use another screening method more often.

For the new study, the researchers randomly assigned 2,000 of their patients to either receive normal colonoscopy preparation instructions or to get an information card and reminder phone call about watching an educational Internet video.

After excluding patients who didn't show up for their colonoscopy or didn't report on their preparations, Jacobson's team had information on 350 people who received normal preparation instructions and 387 who were given the video link.

Of those who were told to watch the video, however, only 24 did. And overall, there was no difference between the two groups when it came to colon cleanliness.

"What it taught us is, before you launch a big trial to see if something makes a difference, you need to have more background information on what your patients really want," Jacobson said.

Dr. Thomas Sequist, who has studied electronic tools to aid colonoscopy preparation but was not involved in the new study, said he's not surprised with the results and believes doctors are finding that not all patients want to learn interactively online.

"There are other populations who don't want to do that, who would rather have it all text-based messaging or rather have it all in an email," said Sequist, an associate professor of medicine at Harvard Medical School in Boston.

He told Reuters Health doctors should find out how patients want to communicate and find a way to let them know the value they'll get from using the tools.

In this case, Sequist said, it would be that learning to properly prepare for a colonoscopy helps avoid the need to do the process a second time.

In an editor's note accompanying the new study in JAMA Internal Medicine, Dr. Grace Lin, a member of the journal editorial board, echoed Sequist's comments.

"Although web-based tools are an important avenue for patient education, this study highlights that even well-designed tools will not be effective if they are not used," she wrote.

SOURCE: http://bit.ly/14wBW6U JAMA Internal Medicine, online June 3, 2013.

[This story corrects name of Dr. Jacobson’s affiliation in paragraph 2.]

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