How Efficacious Are Patient Education Interventions to Improve Bowel Preparation for Colonoscopy? A Systematic Review.
How Efficacious Are Patient Education Interventions to Improve Bowel Preparation for Colonoscopy? A Systematic Review.
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DOI：
10.1371/journal.pone.0164442
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Saini SD
中科院分区：
文献类型：
--
作者：
Kurlander JE;Sondhi AR;Waljee AK;Menees SB;Connell CM;Schoenfeld PS;Saini SD
在大部分结肠镜检查中，肠道准备不足，导致多种临床和经济危害。虽然大多数患者在结肠镜检查前接受某种形式的教育，但对于最佳方法没有达成共识。本系统综述旨在评价患者教育干预措施改善肠道准备的有效性。我们检索了科克伦数据库、CINAHL、EMBASE、奥维德和Web of Science。入选标准为：（1）患者教育干预;（2）改善肠道准备的主要目的;（3）经验证的肠道准备量表;（4）前瞻性设计;（5）同期对照组;（6）成人参与者。使用改良的唐斯和布莱克量表评估研究有效性。筛选了1，080份摘要。7项全文研究符合纳入标准，包括2，660例患者。这些研究评估了多种提供平台，包括基于纸张的干预措施（三项研究），视频（两项研究），结肠镜检查前一天的再教育电话（一项研究）和医生的亲自教育（一项研究）。除一项研究外，其他所有研究的肠道准备都得到了显著改善。除一项研究外，所有研究均在单中心进行。有效性评分范围为13至24（最高27）。五分之四符合纳入标准的摘要和研究信件也显示肠道准备有所改善。统计学和临床异质性排除了荟萃分析。与常规护理相比，患者教育干预在提高肠道准备质量方面似乎有效。然而，由于研究规模小，干预措施的个性化，这些研究的结果可能无法推广到其他环境。在采取新的干预措施之前，医疗保健实践应该考虑系统地评估他们目前的肠道准备教育方法。
Bowel preparation is inadequate in a large proportion of colonoscopies, leading to multiple clinical and economic harms. While most patients receive some form of education before colonoscopy, there is no consensus on the best approach. This systematic review aimed to evaluate the efficacy of patient education interventions to improve bowel preparation. We searched the Cochrane Database, CINAHL, EMBASE, Ovid, and Web of Science. Inclusion criteria were: (1) a patient education intervention; (2) a primary aim of improving bowel preparation; (3) a validated bowel preparation scale; (4) a prospective design; (5) a concurrent control group; and, (6) adult participants. Study validity was assessed using a modified Downs and Black scale. 1,080 abstracts were screened. Seven full text studies met inclusion criteria, including 2,660 patients. These studies evaluated multiple delivery platforms, including paper-based interventions (three studies), videos (two studies), re-education telephone calls the day before colonoscopy (one study), and in-person education by physicians (one study). Bowel preparation significantly improved with the intervention in all but one study. All but one study were done in a single center. Validity scores ranged from 13 to 24 (maximum 27). Four of five abstracts and research letters that met inclusion criteria also showed improvements in bowel preparation. Statistical and clinical heterogeneity precluded meta-analysis. Compared to usual care, patient education interventions appear efficacious in improving the quality of bowel preparation. However, because of the small scale of the studies and individualized nature of the interventions, results of these studies may not be generalizable to other settings. Healthcare practices should consider systematically evaluating their current bowel preparation education methods before undertaking new interventions.
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