Automated Navigation to Improve Colonoscopy Show Rate and Preparation
Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Despite effective screening and treatment strategies, screening rates remain at 59-65%. Screening colonoscopy requires a complex process to identify an escort, purchase the preparation, take a day off from work, adhere to a clear liquid diet, and complete the split-dose preparation as recommended. This results in a significant no-show and cancellation rate, along with suboptimal preparation quality, which can lead to non-adherence and incomplete screening. There is an opportunity to leverage an automated text-message navigation intervention using the Way to Health (W2H) platform to improve patient engagement prior to colonoscopy completion. Through the use of bidirectional text messaging to create a conversation, we will incorporate behavioral economic design elements such as reciprocity, commitment, and interim goal setting. This is a pragmatic randomized controlled trial at Penn Presbyterian Medical Center comparing an automated text-message navigation service to usual care. We will first conduct user testing among 10 patients to refine the messaging, and then enroll 496 patients in the clinical trial. The primary outcome will be the percentage of patients who complete colonoscopy with adequate preparation quality within 3 months of scheduling.