Experience And Compliance With Split Dose Bowel Preparation In A Veteran Population Undergoing Outpatient Colonoscopy

Introduction: Split dose bowel prep is superior to conventional bowel prep, yet few studies have examined patient experiences with this bowel prep. The goal of this study is to evaluate experiences and compliance with split dose bowel prep. Methods: An anonymous survey was conducted at a single VA medical center who completed a split dose bowel prep for outpatient colonoscopy. Bowel prep consisted of a large volume (4 liter) polyethylene glycol plus electrolyte solution, with 2 liters taken the evening prior and 2 liters taken the morning of the exam. Exclusion criteria included those prescribed a conventional full dose bowel prep, age younger than 18 years or older than 90 years, and those unwilling to participate. Questions encompassed patient demographics and experiences with split dose bowel prep. Results: 150 surveys were completed. Mean age was 61 years; 87% were male. 57% were African American and 38% Caucasian. Major indications for colonoscopy included polyp surveillance (21%), screening (18%), and positive fecal immunochemical test (11%). 71% live less than 20 miles from our medical center. The majority (71%) did not stop on their ride to the medical center to have a bowel movement, 17% stopped one time, 8% stopped two times, and 5% stopped more than two times. In terms of patient experiences, 97% found the instructions very clear or somewhat clear. 65% reported receiving a phone call to explain prep instructions, with 65% receiving that call within 7 days of their exam date; 35% received a phone call more than 7 days prior to their exam date. Most (80%) completed the entire split prep; only 2% completed less than half. 85% found the prep easy or somewhat easy to drink; 15% felt it was difficult to complete. The most common side effects from split prep included sleep disturbances (67%), unpleasant taste (47%), nausea (23%), and abdominal cramping (23%). If a repeat colonoscopy with split prep was recommended, most (53%) preferred an appointment prior to 9AM. 75% would recommend the split prep to others. Conclusion: Most patients who took a split dose bowel prep for outpatient colonoscopy understood the instructions, completed the prep, had few side effects, and would recommend the split dose bowel prep. Despite the commonly held negative beliefs among health care staff that patients would be unwilling or unable to complete a split prep, our study highlights that there is excellent compliance and, overall, positive experiences among outpatients who completed a split dose prep.