Abstract
5 min readIntroduction: Among cancers diagnosed in both males and females, colorectal cancer (CRC) is the second most common cancer and the third leading cause of cancer-related death in the United States. CRC also has the second highest cost of any cancer in the United States.Colonoscopy, as the gold standard for CRC screening, is the most sensitive test and can be both diagnostic and therapeutic. Recent trials have shown that mobile apps have improved patient adherence to bowel preparation and colonoscopy appointments. We conducted a scoping review to evaluate the impact of smartphone application (SPA) technology in patients undergoing elective colonoscopy to measure compliance with appointments, cost-effectiveness, bowel preparation, and quality of life. Methods: This scoping review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Ovid Medline, Web of Science, ScienceDirect, Scopus, Cochrane Library, and PubMed were screened up to Oct 14, 2020, and bibliographies of the retrieved articles were included. Based on prespecified inclusion and exclusion criteria, 8 primary studies were included in the final analysis from a total of 3,979 nonduplicate articles. Results: Seven studies included bowel preparation efficacy in their main objectives.The majority of studies used Boston Bowel Preparation Scales (BPPS) to assess bowel preparation. Adherence to colonoscopy screening was assessed by one study.Adherence to diet and laxatives was assessed by three studies.Quality of life and patient satisfaction during the peri-procedural period of colonoscopy were assessed by five studies. Cost-effectiveness was not assessed by any studies are included. Conclusion: In six studies; patients in the smartphone group had a successful bowel preparation when compared with the control arm; on the other hand, one study did not find any differences between groups. Adherence to colonoscopy screening was assessed by one study. Patients in the digital intervention arm were significantly more likely to complete a screening test. Patient satisfaction during the periprocedural period of colonoscopy was assessed by five studies which reported significantly higher patient satisfaction in the intervention arm compared to the control arm. None of the studies measured cost-effectiveness. Study characteristics and detailed results are provided in Table. Future trials investigating SPAs should include cost-effectiveness and adherence to appointments as an endpoint. Table 1. - Study and patient characteristic charting form Study Intervention Study design Population Age Outcomes Results Sharara et al., 2017 Mobile App RCT, Colonoscopist blinded 160 >18 Primary outcome: Adherence with instructions No statistical difference in overall adherence (p=0.40) or bowel cleanliness (p=0.68). Walter et al., 2020 Mobile App RCT, Colonoscopist blinded 500 >18 Primary outcome: Quality of preparation (BPPS) Secondary outcome: Compliance with diet and laxatives. Discomfort from the prep. App compare to standard instruction; BPPS (7.6 ± 0.1) vs (6.7 ± 0.1) (p< 0.0001),Insufficient bowel prep 8% vs 17% (P = .0023), Adenoma detection rate 35% vs 27% in controls (P = .0324), Adherence and decreasing level of discomfort (p< 0.0001). Denizard-Thompson et al. 2020 Mobile App RCT 408 >18 Primary outcome: Chart-verified completion of a CRC screening test within 24 weeks Secondary outcome: Benefits, barriers to screening, self-efficacy, ability to state a screening decision, intent to screen within 30 days and patient/provider discussion mPATH-CRC arm vs control arm;completing of CRC screening 30% vs. 15%, Ordering the test 69% vs. 32%, Overall, patients in both the mPATH and Control arms were equally likely to complete colorectal cancer tests once they were ordered (43% and 46% respectively, P = 0.70) Lorenzo-Zuniga et al. 2015 Mobile App RCT, Colonoscopist blinded 260 >18 Primary outcome: Bowel prep quality Secondary outcome: Patient satisfaction with a specific questionnaire Mobile App vs Control armNumber of Optimum bowel prep (100% vs 96.1%,P=0.037 respectively. Also, patient-reported tolerability and overall experience with the prescribed bowel preparation was significantly higher for mobile app group Cho et al. 2017 Mobile App RCT, Colonoscopist blinded 142 >18 Primary outcome: The quality of bowel cleansing using the BBPS. Secondary outcome:Patient satisfaction with a specific questionnaire Mobile App vs control arm BBPS (7.70±1.1 vs. 7.24±0.8, respectively, p=0.007). The mean score of the satisfaction questionnaire was significantly higher in the App group than that of the control group (app group: 7.62±2.2 vs. control group: 5.97±2.2, p< 0.001). Walter et al. 2017 Mobile App RCT, Colonoscopist blinded 50 >18 Primary outcome: Stable function of the developed mobile app during colonoscopy preparation time. Secondary outcome: The quality of bowel cleansing using the BBPS. The smartphone app prototype was sufficiently working with stable function during the time of colonoscopy preparation in smartphone app group patients. For Bowel cleanness assessment; mean BBPS score was 8.1 (SD 0.25) versus 7.1 (SD 0.41) (P=.02 for difference) (control group). Guo et al. 2019 Mobile App RCT, Colonoscopist blinded 293 >18 Primary outcome: Rate of adequate bowel preparation according to BBPS Scale Secondary outcome: Compliance with instructions,side effects and rates of adenoma detection Rate of adequate bowel prep Mobile App vs Control (77.2% vs. 56.8%, p < .001), The adenoma detection rate (ADR) (21.4% vs. 12.8%, p = .029), The rates of incomplete compliance with instructions: (15.17% vs 33.11%, p < .001), The overall adverse events SPA vs Control (23.45% and 37.84%, p = .008) Brief et al.2020 Mobile App RCT, Colonoscopist blinded 46 < 1 8 Primary outcome: Bowel preparation quality BBPS score Secondary outcome: Patient arrival time to endoscopy suite, calls to gastroenterology service, Subjects with improved knowledge after receiving materials Mobile App vs control groupBowel prep quality BBPS 7.2 (range 3-9) versus a mean score of 5.9 (range 3-9) (P=.02), Arrival time average 46 mins vs 44 mins (p=.56), Calls to gastroenterology service 6 vs 2 (p=.27), Subjects with improved knowledge after receiving materials %; 50 vs 36 (p=.37)
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