It’s the Prep People Dread – Not the Colonoscopy

SKOKIE, Ill. – The No. 1 complaint people have about colonoscopy is not the procedure itself -- it’s the preparation for the procedure, according to a survey of nearly 2,000 patients who underwent colonoscopies at 107 of the nation’s ambulatory surgery centers, which combined provide nearly 500,000 colonoscopies per year.

The survey was conducted by the AAAHC Institute for Quality Improvement (AAAHC Institute), a not-for-profit subsidiary of the Accreditation Association for Ambulatory Healthcare (AAAHC/Accreditation Association).

"This is important information for physicians and patients," said Naomi Kuznets, PhD, managing director of the AAAHC Institute. "Our reports help identify ways that ambulatory organizations can improve the quality of patient care. Paying special attention to patients’ comfort with preparation regimens may be an important contributor to high quality outcomes in organizations that perform colonoscopies."

The AAAHC Institute report found:

• One-third (34 percent) of patients reported mid-range to severe discomfort from the preparation regimen to clean the bowel. In contrast, only 5 percent of patients reported the same range of discomfort during the colonoscopy procedure itself.
• Of 288 patients (15 percent) who reported their prep regimen was "almost severe" or "severe," 22 of 278 (8 percent) reported they would NOT have the procedure again (10 did not answer this question).

Colorectal cancer screenings are the second most frequently performed procedures in ambulatory care settings, with nearly 10 million performed each year. Colon cancer is the second leading cause of cancer death in the U.S., accounting for 56,000 deaths per year. Estimates are that up to 90 percent of colorectal cancers could be prevented with regular screening of people over age 50.

Preparing for the Prep
Preparation prior to a colonoscopy is required to remove all fecal matter so that the physician performing the exam will have a clear view of the colon. According to Lawrence S. Kim, MD, FACG, gastroenterologist at South Denver Gastroenterology in Denver, the following are tips for patients preparing for colonoscopy:

• Discuss any concerns you have about the prep and ask your physician, nurse or other healthcare provider what the options are. Work with them to choose a preparation regimen that seems right for you. The three most common types of prep regimens are:

1. PEG (polyethylene glycol) solutions, which consist of a powder that is mixed with two to four liters of water. Typically, patients are asked to drink an eight-ounce glass of the mixture every 10 minutes until the solution is finished and all eliminations from the colon are clear.
2. Phospho-soda. In this technique, patients drink a mixture of phospho-soda and water, followed by the use of a laxative and an enema or suppository, depending on the physician’s directions.
3. Sodium phosphate tablets. Depending on the brand, patients take from 28 to 40 tablets with water at regular intervals the evening before and the day of the colonoscopy.

• Make sure you receive clear, written instructions about your prep and that you follow them carefully – poor preparation may mean that you have to do it all over again.
• Limit your activities. You should be prepared to spend several hours in the bathroom the evening before your colonoscopy.
• Drink plenty of other clear liquids in addition to the water that is part of the prep regimen. Your body needs a combination of fluids, sugar, and electrolytes. This will help you avoid dehydration and the prep will be easier to tolerate.
• Call your doctor if you are having any trouble such as vomiting or abdominal pain, or if you don’t understand the instructions. Your doctor also may want you to call if you do not have clear eliminations after taking the prep.
• Remember that getting the prep right not only may keep you from having to undergo a repeat exam, it will also improve the chances that any pre-cancerous growths (polyps) will be seen and removed by the doctor performing the exam.

Other findings from the AAAHC Institute’s colonoscopy study include:

• 86 percent of patients said they had prior knowledge of the procedure, and 98 percent of those stated they had an adequate understanding of the procedure.
• Despite recent increases in colon cancer/colonoscopy campaigns, the greatest number of people said they heard about the procedure from friends or family (40 percent). Another 24 percent said they’d had a prior colonoscopy, while 8 percent said they were informed by physicians or other healthcare workers and 8 percent said they had seen awareness advertising.

About the Study
The colonoscopy study collected real-time data from August to November 2007 and was the seventh in a series of colonoscopy best practices studies conducted by the AAAHC Institute since 2001. Study results should not be used, nor were they designed, to assign "relative values" to processes and outcomes or to set reimbursement policies.

To order copies of the report or for more information, please visit the AAAHC Institute online at www.aaahciqi.org.

Source: AAAHC