Randomized Controlled Trial
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2020; 26(47): 7568-7583
Published online Dec 21, 2020. doi: 10.3748/wjg.v26.i47.7568
Evaluation of an educational telephone intervention strategy to improve non-screening colonoscopy attendance: A randomized controlled trial
Agustín Seoane, Xènia Font, Juan C Pérez, Rocío Pérez, Carlos F Enriquez, Miriam Parrilla, Faust Riu, Josep M Dedeu, Luis E Barranco, Xavier Duran, Inés A Ibáñez, Marco A Álvarez
Agustín Seoane, Xènia Font, Juan C Pérez, Rocío Pérez, Carlos F Enriquez, Miriam Parrilla, Faust Riu, Josep M Dedeu, Luis E Barranco, Inés A Ibáñez, Marco A Álvarez, Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
Agustín Seoane, Faust Riu, Josep M Dedeu, Luis E Barranco, Marco A Álvarez, Colorectal Cancer Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona 08003, Spain
Josep M Dedeu, Marco A Álvarez, Department of Medicine, Autonomous University of Barcelona, Barcelona 08003, Spain
Xavier Duran, Consulting Service on Methodology for Biomedical Research, IMIM (Hospital del Mar Medical Research Institute), Barcelona 08003, Spain
Author contributions: Seoane A contributed to conception and designed of the study, analysis and interpretation of data; Font X, Pérez JC, Pérez R, Enriquez CF and Parrilla M contributed to acquisition of data; Duran X contributed to the statistical analysis; Riu F, Dedeu JM, Barranco LE, Ibáñez IA and Álvarez MA contributed making critical revisions and related to important intellectual content of the manuscript.
Supported by Hospital del Mar, Parc de Salut Mar.
Institutional review board statement: The study was approved by the ethics committee of IMIM, Hospital del Mar Medical Research Institute (7739/I).
Clinical trial registration statement: This study is registered at https://clinicaltrials.gov/ct2/show/NCT03458377. The registration identification number is NCT03458377.
Informed consent statement: All involved persons (subjects and legally authorized representatives) gave their written informed consent.
Conflict-of-interest statement: There are no conflicts of interest for any of the authors.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Agustín Seoane, MD, Attending Doctor, Research Scientist, Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Passeig Marítim, 25-29, Barcelona 08003, Spain. 92847@parcdesalutmar.cat
Received: September 15, 2020
Peer-review started: September 15, 2020
First decision: November 3, 2020
Revised: November 16, 2020
Accepted: November 29, 2020
Article in press: November 29, 2020
Published online: December 21, 2020

Colonoscopy attendance is a key quality parameter in colorectal cancer population screening programmes. Within these programmes, educative interventions with bidirectional contact carried out by trained personnel have been proved to be an important tool for colonoscopy attendance improvement, and because of its huge clinical and economic impact, they have been widely implemented. However, outside of this population programmes, educative measures to improve colonoscopy attendance have been poorly studied and no navigation interventions are usually performed.


To investigate the clinical and economic impacts of an educational telephone intervention on colonoscopy attendance outside colorectal cancer screening programmes.


This randomized controlled trial included consecutive patients referred to colonoscopy from primary care centres from November 2017 to May 2018. The intervention group (IG) received a telephone intervention, while the control group (CG) did not. Patients assigned to the IG received an educational telephone call 7 d before the colonoscopy appointment. The intervention was carried out by two nurses with deep endoscopic knowledge who were previously trained for a telephone educational intervention for colonoscopy. The impact on patient compliance with preparedness protocols related to bowel cleansing, anti-thrombotic management, and sedation scheduling was also evaluated. A second call was conducted to assess patient satisfaction. Intention-to-treat (ITT) and per-protocol (PP) analyses were performed.


A total of 738 and 746 patients were finally included in the IG and CG respectively. Six hundred thirteen (83%) patients were contacted in the IG. The non-attendance rate was lower in the IG, both in the ITT analysis (IG 8.4% vs CG 14.3%, P < 0.001) and in the PP analysis (4.4% vs 14.3%, P < 0.001). In a multivariable analysis, belonging to the control group increased the risk of non-attendance in both, the ITT analysis (OR 1.81, 95%CI: 1.27 to 2.58, P = 0.001) and the PP analysis (OR 3.56, 95%CI: 2.25 to 5.64, P < 0.001). There was also a significant difference in compliance with preparedness protocols [bowel cleansing: IG 61.7% vs CG 52.6% (P = 0.001), antithrombotic management: IG 92.5% vs CG 62.8% (P = 0.001), and sedation scheduling: IG 78.8% vs CG 0% (P ≤ 0.001)]. We observed a net benefit of €55600/year after the intervention. The information given before the procedure was rated as excellent by 26% (CG) and 51% (IG) of patients, P ≤ 0.001.


Educational telephone nurse intervention improves attendance, protocol compliance and patient satisfaction in the non-screening colonoscopy setting and has a large economic impact, which supports its imple-mentation and maintenance over time.

Keywords: Colonoscopy, Quality improvement, No-show patients, Nursing education, Patient compliance, Telephone intervention

Core Tip: This is the first randomized controlled trial that demonstrates that an educational intervention improves colonoscopy attendance in the non-screening colonoscopy setting. We found that bidirectional communication is the crucial point in reducing the non-attendance rate and telephone contact is a valid educational option. An endoscopy nurse is also a valid person to conduct the educational intervention and could be the ideal person to eliminate barriers that negatively influence the patient’s attendance. This educational intervention also improves protocol compliance and patient satisfaction and has a large economic impact, which supports its imple-mentation and maintenance over time.