Patient Engagement Quells Colonoscopy Fears

By Scott Westcott, Contributing Writer

Dartmouth-Hitchcock Medical Center uses Web-based video programming to educate and engage colonoscopy patients, which is calming their nerves and saving the hospital time and money.

Few medical appointments evoke more anxiety than the dreaded colonoscopy.

The procedure is recommended for anyone over the age of 50 to screen for colon cancer, yet some patients aren’t keen on what they perceive as an embarrassing or downright scary experience.

Indeed, medical practitioners say fear and uncertainty often prevent people from scheduling and undergoing a colonoscopy. A CDC study found that 28 percent of people over the age of 50 have not been screened for colon cancer, largely due to concerns about the preparation and the actual procedure.

“Thinking about having a long, lighted tube inserted into the colon certainly doesn’t sound like something that would be an easy thing, so the biggest concern, particularly for those having it for the first time, is they just don’t know what to expect,” says Dr. Corey Siegel, M.D., a gastroenterologist with Dartmouth- Hitchcock Medical Center in Lebanon, NH. “There’s a lot of anxiety around the preparation. There’s also a lot of nervous anticipation due to not really understanding what the procedure involves, and concern about what the potential findings might be.”

Web Program Provides Patient Education On Demand
Dr. Siegel, along with a team of graduate students from the Geisel School of Medicine at Dartmouth, wanted to see if there was a simple way to reduce patient anxiety while raising understanding and awareness about the potentially life-saving procedure. Specifically, they aimed to measure whether watching a 20-minute interactive, Web-based media program about colonoscopies would make patients feel more at ease and confident before, during, and after the procedure.

Chicago-based Emmi Solutions produces and distributes the Web program, one of many that the firm offers to healthcare systems as a means to empower patients with greater understanding about specific procedures. Emmi emphasizes that its programs serve a critical role in deepening patient engagement, citing research that patients forget up to 80 percent of what their doctor says by the time they reach the parking lot following an appointment.

Emmi’s programs walk patients through every aspect of a medical procedure and can be watched at the patient’s convenience on a home computer. The information is provided in a straightforward, easy-to-understand format. For instance, the colonoscopy program features a frank, sometimes wry narrator who addresses sensitive subjects, such as whether the procedure will increase hemorrhoid pain or acknowledging that “it is kind of icky” to discuss how a patient knows if their colon is cleaned out prior to the colonoscopy.

The Emmi system also offers tracking data for the healthcare organization to assess how many patients actually view the program, as well as providing data that can help the organization more easily identify ways to improve the patient experience, address common concerns, or create new cost efficiencies.

Patient Engagement Makes Measurable Impact
Dr. Siegel’s research team conducted a randomized controlled study investigating the impact of the program on colonoscopy patients. As part of the study, 51 patients were given Dartmouth-Hitchcock’s standard printed preprocedure colonoscopy packet. Meanwhile, 52 patients were instructed to watch the Web-based colonoscopy program, in addition to receiving the same printed packet. On the day of the colonoscopy, prior to the procedure, participants in both groups were asked to fill out a survey to assess their knowledge of colonoscopy, their emotional state prior to the procedure, and their understanding of potential outcomes. In addition, the average procedure time and amount of pain medication administered were measured.

The results: Patients who viewed the Emmi Solutions colonoscopy program prior to their procedure had decreased anxiety, lower sedation medication requirements, and shorter procedure times compared with those who received only the standard printed preprocedure packet. Of those who watched the program, 60 percent reported it decreasing their anxiety, compared to 4 percent who said it increased anxiety.

The team concluded that the Emmi program not only increased patient knowledge and comfort levels, but could also lead to increased organizational efficiency and lower costs by saving staff time and using lower doses of sedative medications. Patients who watched the Emmi program:

• required 18 percent less sedation medication
• had a 14 percent decrease in procedure time
• were 11 percent more knowledgeable about the colonoscopy.

So why did those who viewed the program require less medication and experience faster procedure time as opposed to those who were only given printed materials?

“People are coming in less anxious, and those who are less anxious are likely falling asleep more easily with the sedating medications,” Dr. Siegel says. “If they are more comfortable with what is about to happen to them, then the procedure may require less sedation and the entire process is quicker and easier for the patients.”

The time-savings aren’t merely a benefit for the patient. It could ultimately be a significant factor in controlling costs and increasing efficiency for healthcare providers. For example, Dr. Siegel emphasizes that the 14 percent decrease in procedure time translates to about five less minutes per patient. With about 50 colonoscopies being performed daily at a facility like Dartmouth-Hitchcock, that kind of time-savings could quickly add up.

“It means people coming in and out of the endoscopy suite more quickly, and anyone sitting in a hospital room costs money,” Dr. Siegel says. “It could add up to quite a bit of time- and cost-savings in a single day, and of course over weeks, months, and years it can really make a difference.”

Beyond Colonoscopies
Dr. Siegel thinks the Emmi programs are crafted in a way that connects with patients, while also offering an easy-to-navigate platform. For instance, patients can backtrack or skip forward, and the program has a simple note-taking function. A printable summary, including notes or questions that were added during viewing, is available at the conclusion of the program.

“I think these Web programs very nicely walk the line of clarity — not making it overly simplistic,” Dr. Siegel says. “It’s told in a very straightforward way that is engaging, yet not overwhelming.”

“My feeling is that when you are a patient about to drift off to sleep with anesthesia, you will be more comfortable because you know the safety of the procedure and understand what the doctor’s going to be doing, and you come in with a much higher level of confidence that you understand the whole process.”

Ultimately, Dr. Siegel and his team see this multimedia approach as having application across a number of clinical areas besides colonoscopy, leading to better patient experience and better outcomes. “As we’ve shown, patients are coming in for procedures less anxious and more knowledgeable. And that’s often leading to quicker and easier procedures, so it’s a nice combination,” says Dr. Siegel. “If we can better educate patients, engage them in the process, and therefore lower their anxiety and worry, then it makes their experience better.”