| Summary: | 碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士在職專班 === 106 === Objective
Colonoscopy is the primary tool for screening colorectal cancer. However, how to improve the bowel preparation quality before colonoscopy is a necessary task for the completion of colonoscopy. This research aims to explore the effect of differences in awareness, colonoscopy perception on painfulness, patient satisfaction and colonoscopy report inspection quality on the patients receiving colonoscopy after the intervention of health education video played by mobile tablet.
Methods
The prospective Quasi-experimental design was applied in this study, with the data collected from the teaching hospital in southern part of Taiwan. The medical care colleagues in Endoscopy Center and Management Office were engaging in discussing and producing “Tablet Visual Health Education Video” as an interventional measure. The objects of the case were patients over 20 years of age, making outpatient appointment for colonoscopy, who were clear without previous diagnosis of mental disorder/mental illness. The study divided the patients into two groups in a random and double-blind manner for comparison with random number table. The investigation was conducted from July 1, 2017 to December 31, 2017 with 280 persons receiving and filling in the questionnaires in total. However, after removing colonoscopy reports and incomplete questionnaire data, the actual questionnaires collected were 239, with 106 from the case group and 133 from the control group. The study also compared the effects of these two health education on bowel preparation, inspection time, whether there is polyps, whether there is adenomatous polyposis in the clinical aspect as well as the effect on examination cognition, colonoscopy perception on painfulness and patient satisfaction. Moreover, the research also discussed relevant factors influencing colonoscopy quality through referring to the basic personal information of patients.
Results
The colonoscopy of the case group showed a significant difference in terms of health education cognition, indicating that the cognition of case case group was higher than that of control group (p=0.002), however, there were no significant differences in demographic and clinical characteristics.
There was no significant difference among two groups in respect of colonoscopy perception on painfulness (p=0.415), but there was a significant difference in terms of demographic and clinical characteristics. Female’s perception of pain was higher than that of male (p=0.009), while patients with senior high school education background felt less painful than those with middle school education background (p=0.007). Those patients having meal replacement before examination felt more painful than those having foods self-prepared (p=0.014). The longer the total examination time was, the more painful patients would feel (p<0.001).
The higher the cognition on health education of the case group, the higher the dissatisfaction with the colonoscopy (p=0.003), possibly because the patients were with higher education, therefore requiring higher standards. However, patients who had no significant differences in education but with significant differences in clinical characteristics factors, who are undergoing abdominal surgery felt satisfied (p0.013). The more painful the patients perceived, the less they felt satisfied (p=0.045).
As for bowel preparation, the patients in case group had a better bowel preparation with OR=0.55, 95%CI=0.30-0.98, p=0.044. In terms of gender, male patients had a better bowel preparation with OR=0.49, 95%CI=0.27-0.88, p=0.017. Patients aged from 56 to 64 had a better bowel preparation than those aged over 75 with OR=0.28, 95%CI=0.08-0.98, p=0.046.
As for withdrawal time, patients aged <=55, between 56 and 64 and over 75 was different. The younger they were, the shorter the time was (p=0.011. p=0.014). In terms of the duration spent on examinations, patients that went through examinations for a third time spent a shorter amount of time than that of the first-timers (p=0.011). The time taken by 2 physicians in Gastroenterology Department certified by The Gastroenterological Society of Taiwan showed significant differences (p<0.001).
With respect to total examination time, male patients took less time (p=0.007). Among patients <=55, between 56 and 64 as well as over 75, the younger the patients were, the less time the examination took (p=0.004, p=0.005). Patients with senior high school and middle school education background spent less time in examination (p=0.024) and there were significant differences between 2 physicians in Gastroenterology Department in terms of examination time.
In terms of adenomatous polyposis, the adenoma found in males was more than that found in females with OR=1.94, 95%CI=1.05-3.58, p=0.033. Less adenoma was found in patients aged <=55 than that was found in patients over 75 with OR=0.27, 95%CI=0.08-0.91, p=0.034. Less adenoma was found in patients having meal replacement before examination with OR=0.52, 95%CI=0.27-0.98, p=0.045, and significant differences were found if examined by different physicians with OR=2.31, 95%CI= 1.25-4.28, p=0.008.
Conclusion and Suggestions
The educational mode with mobile tablet intervened into colonoscopy was applied to understand the differences of this mode with the original health education mode as well as to serve as the reference for medical institutes to educate patients. By this, the medical staffs can not only take care of patients but also provide patients with better knowledge and health education methods. In the meantime, patients can be more concern about their health issues, which further improve their satisfaction with and trust in the medical institutes. It is recommended that the future researches should utilize medical research samples from hospitals all over the country at different levels and attributes as a source to collect follow-up of colonoscopy patients for years to analyze statistical trends.
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