Having text message conversations with patients 1 week before they are scheduled for a colonoscopy decreased “no-show” rates, according to a recent study published by Mahmud et al in Health Education & Behavior. Through sending reminders and instruction, the team increased the rate of colonoscopy adherence to 90%, vs the 62% success rate seen in patients who did not receive this extra communication.

“Texting is also especially appealing to health systems because it is scalable and efficient—it’s a tactic many others have employed in order to communicate with patients.”

— Nadim Mahmud, MD, MPH

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“Automated text messaging and new insights from behavioral science offer opportunities to effectively and efficiently engage with patients before important health prevention activities,” said the study’s senior author, Shivan Mehta, MD, MBA, Assistant Professor of Medicine and Associate Chief Innovation Officer at Penn Medicine. “It’s also important to keep in mind that these programs should be conducted in close partnership with clinical operations, and that we understand patient perspectives about these interventions.”

Despite being the second-leading cause of cancer death in the United States, one in three people are not up-to-date on screening for colorectal cancer. As such, researchers are exploring how technology and the framing of messages affect screening rates.

Methods

In April 2018, the researchers asked 22 patients scheduled for outpatient colonoscopy to participate in their text messaging program, featuring automation and two-way messaging powered by the Way to Health platform. These 22 patients were compared to 50 patients in a control group who received the standard paper instructions and phone call reminder.

Examples of the automated messages sent to patients included:

• A congratulatory text and colonoscopy date reminder upon enrollment
• A reminder with the office’s address linked and a prompt for any questions about the procedure 1 week prior to their appointment
• A nudge to pick up prep materials (such as sports drinks and laxatives) from the pharmacy 5 days prior
• Messages to prompt each step of the prep sequence the night before the appointment.

If patients responded with questions to any of the text prompts—which three-quarters of them did—the queries were escalated to gastroenterology staff, who answered within 24 hours.

“We think text[ing] is successful because it is patient-centered. It is already widely used by our patient population, does not require much effort by the patient to participate, and patients can read or respond whenever they choose,” said lead study author Nadim Mahmud, MD, MPH, a hepatology fellow at the Hospital of the University of Pennsylvania. “Texting is also especially appealing to health systems because it is scalable and efficient—it’s a tactic many others have employed in order to communicate with patients.”

Additional Findings

While the texting dramatically increased rates of success and was popular among the patients, the study showed that it didn’t actually change the quality of preparation among patients compared to those who just got a reminder call and paper instructions. This aspect of the program will likely be examined somewhat closer in the next phase of this study, which is being conducted currently with roughly 750 patients.

“We are evaluating the effectiveness of this service among a broader population and, in this new trial, we are automating some aspects of recruitment and engagement so that it will be easier to scale to routine operations across multiple endoscopy clinics,” explained Dr. Mehta.

Disclosure: This study was supported in part by the National Center for Advancing Translational Science and the Institute for Translational Medicine and Therapeutics at the University of Pennsylvania. For full disclosures of the study authors, visit journals.sagepub.com.