Ask an answerable question (PICO)：
The quality of bowel preparation impacts the success of colonoscopy. The clients can choose between the prepackaged low-residue diet (PLRD) and self-prepared low-residue diet (SLRD) depending on their preference. They also inquire about the effectiveness of the prepackaged low-residue diet in clinical setting. This article uses evidence-based method to evaluate the impact of prepackaged and self-prepared low-residue diet on bowel preparation for colonoscopy.
The Method and Analysis of Literature Review：
The literature search was conducted following the 5A steps of evidence-based nursing, using PICO (Patient, Intervention, Comparison, and Outcome) criteria to define keywords and corresponding controlled vocabulary terms. Boolean logic was applied to execute the search. The review was restricted to original articles published in English and Chinese, without limitations on the time frame. A total of 49 articles were found from Cochrane Library, Embase, PubMed, Web of science, and CEPS (Chinese Electronic Periodical Services). After excluding groups with varied laxatives/doses, duplicates, expert opinions, and inaccessible articles, 5 eligible articles were found: 4 randomized controlled trials (RCTs) and 1 meta-analysis (MA). The MA included 3 RCTs. The review ultimately covered 1 MA and 1 RCT.
Critical Appraisal：
The selected articles were assessed using the CASP (Critical Appraisal Skills Programme) checklist appropriate to their study type. Two articles received an evidence level of Level II for the systematic review and Level II for the randomized controlled trial, and a recommendation grade of A. The literature review indicated that PLRD could significantly increase the proportion of patients with adequate bowel preparation.
Clinical Application of Evidence：
Use empirical knowledge to translate the seven-step implementation plan, and analyze the results, and set up an empirical group on March 1, 2023.
This study integrates education on low-residue meal replacements into standard procedures and revises bowel preparation protocols, comparing completion rates among different dietary approaches for optimal bowel preparation.
Evaluation of Effectiveness：
The clinical application results revealed an overall improvement in bowel preparation from 54.5% to 76.3%. The study findings showed no significant difference in rate of adequate bowel preparation between the PLRD group and the self-prepared low-residue diet group. However, older individuals were more likely to prefer PLRD (t=5.00, P<.000).
Conclusions and Recommendations：
While the literature review indicates that PLRD effectively improves bowel preparation compared to SLRD, healthcare professionals can provide dietary guidance according to each patient's preferences. However, we can consider recommending PLRD for bowel preparation to older clients and those who have difficulty preparing their diets.
周佩君* 黃淑麗
