Background: Colonoscopy is a very important screening tool for early cancer detection. The quality of bowel preparation before colonoscopy is closely related to a successful and complete colonoscopy examination. Inadequate bowel preparation can result in failure or decrease in detection of neoplastic lesions and has been linked to an increased risk of procedural adverse events. PEG、NaP and SPMC are common oral cathartics for optimal colon preparation. Using evidence-based approaches to the different types of cathartic agents and taking into account Shared-Decision Making considerations (where patient preferences, tolerability, and compliance are taken into account), we came up with the optimal result in colon preparation and patient satisfaction. Not only were we able to improve the quality of colon preparation, improve ADR (adenoma detection rate), we also reduced unnecessary costs of repeating the examination while improving overall satisfaction and patient customer experience.

  Methods: Using 5 steps of Evidence-based medicine, we carefully searched and analyzed the pros and cons of the major bowel cleansing agents. We presented these EBM findings (quality of preparation, taste, side-effects, patient acceptability, pricing) to our patients for them to choose. To improve patient compliance rate, we created a Patient-Instruction-Sheet that clearly labeled flow charts or illustration and web address that included an Instruction Video. Due to the convenient accessibility and easy to understand language, we were able to elevate our patients’ health literacy in this topic.

Result: The rate of inadequate bowel preparation decreased from 3.3% in 2018 to 2.0% in 2019. The compliance rate to clear diet increased from 65.7% in 2018 increase to 78.2% in 2019. The adenoma detection rate (ADR) increased from 19.0% in 2018 to 20.9% in 2019.