Poor comprehension of colon preparation process in an Appalachian population

Indraneel Reddy¹, Manan Jhaveri¹, Uday Shankar², Lisbeth Selby^1
1University of Kentucky, Department of Internal Medicine, Division of Digestive Diseases and Nutrition, Lexington, KY, USA; ²Hazard Appalachian Regional Healthcare, Hazard, KY, USA

Abstract: Clear liquids are often part of colonoscopy preparation instructions, regardless of the active cleansing agent. Poor understanding of this facet may yield poor preparation with delays in management. We studied comprehension of this facet of colon preparation in an Appalachian population. Our survey contained demographic items and a list of food items from which subjects could select clear liquids. In Phase I, no prompting was given. In Phase II, subjects reviewed the definition of clear liquids and examples a few minutes before the survey. For Phase III, the survey contained the definition of a clear liquid and examples. Persons about to undergo colonoscopy and companions who escorted them were surveyed, since many persons have help during the preparation process. With the Fisher exact probability test, we compared the association of accurately selecting clear liquids ≥ or <80% of the time with education > or ≤12th grade, age, gender, and subject’s stated understanding of preparation. Mean age for all subjects was 52 years and 59% of subjects were female. The majority had ≤12 years of education. Most subjects reported understanding their preparation instructions and yet the minority had ≥80% accuracy on clear liquid selection (range 6%–16%). Phases I–III represent a continuum of progressively more accessible information about clear liquids. Comparison across the 3 phases, for both patients and companions, did not reveal significantly improved clear liquid selection. Multivariate analyses of the above variables, with % correct answer as the dependent variable for all the subgroups, did not reveal any significant associations. Persons from Appalachia do not seem to understand a key portion of the colon preparation process. We demonstrate no significant predictors of understanding the clear liquid aspect of colon preparation. Simple measures to augment comprehension have no clinically significant effect.

Keywords: clear liquids, colonoscopy, Appalachian population