Ask an answerable question (PICO):
Colonoscopy is a method for diagnosing, preventing, and treating colon cancer. Insufficient bowel preparation may decrease bowel cleanliness, thereby affecting colonoscopy quality. Bowel preparation involves the administration of cathartics and ensuring sufficient food intake and fasting duration; however, these functions must be performed according to the examination time, which is considered as an important obstacle by patients. The author observed that clinical nurses would instruct patients to follow a clear liquid diet one day before colonoscopy. However, some patients refused to follow the clear liquid diet due to hunger and continued with the original low-residue diet. Despite this, colonoscopy could still be successfully performed, and adequate bowel cleanliness was also achieved. This triggered the author to examine the effectiveness of a low-residue diet and a clear liquid diet on bowel preparation and level of evidence to improve patient compliance for colonoscopy preparation.
The Method and Analysis of Literature Review:
Five steps of an evidence-based process were followed to determine an answerable question. We searched Cochrane library, PubMed, ClinicalKey medical database, UpToDate, and Airiti Library to find articles that conformed to PICO by using MeSH terms, synonyms, and truncated words for each element of PICO. Searched 29 articles in total. Duplicate articles were deleted, and articles that were not related to the subject, non-hospitalized adult patients that were inconsistent with the subject and the study design were excluded. Including one systematic review (SR) and two randomized controlled trials (RCTs), 2 RCTs are not included in the SR.
Critical Appraisal:
The literature evaluation tool uses CASP's systematic literature review checklist and randomized controlled trial checklist to conduct three-dimensional evaluation. The clinical research evidence level recommended by the Centre for Evidence-Based Medicine in Oxford University is adopted. Literature 1 is focused on content, has integrated analysis and risk of error, and can be used clinically, so it is rated as Level 1. Although Literature 2 and Literature 3 cannot blindly blind the diet content due to the treatment benefit, the blind diet content is difficult in research design. In the research design, blinding the doctor performing the examination has reduced the risk of deviation, so the evaluation is as follows: Level II. Based on the major findings in the three papers, there was no significant difference observed in bowel cleanliness between patients who followed a clear liquid diet and those who followed a low-residue diet for colonoscopy preparation. However, a low-residue diet was determined to be better than a clear liquid diet in terms of satiety and tolerability.
Clinical Application of Evidence:
After a discussion on clinical optimization, the diet was changed to a low-residue diet one day before colonoscopy based on literature recommendations, and the effects of the two types of diet on bowel preparation were compared. In the adjusted bowel preparation content, only the diet on the day before the examination was changed to a low-residue one and other bowel preparation items remained unchanged. If the attending physician determined that the patient was not suitable for a low-residue diet, then a clear liquid diet was administered one day before examination. Before the promotion, nurse education and training and health education revisions were performed.
Evaluation of Effectiveness:
From January to December 2020, a total of 110 patients were admitted to the gastroenterology ward and required colonoscopy. The effects of a low-residue diet and clear liquid diet on bowel preparation were examined. The study subjects, of whom 71 were males (64.5%), were aged between 22 and 90 years with a mean age of 61.8±16.3 years. The bowel preparation completion rate was 87.3%, bowel cleanliness conformance was 68.2%, and no other second examination was carried out. Statistical tests was used to analyze whether there were significant differences in gender and age between the two groups. There were no significant difference in bowel preparation completion and bowel cleanliness.
Conclusions and Recommendations:
The literature review results and clinical application results showed that a low-residue diet and a clear liquid diet one day before colonoscopy did not significantly affect bowel cleanliness. However, the low-residue diet could reduce hunger during bowel preparation, thereby increasing patient compliance, This strategy is regarded as a feasible strategy and is being continuously implemented. In addition to updating the bowel preparation procedure, education Training, updating health education leaflets, and revising nurses’ pocket editions in clinical promotion can increase bowel preparation completeness and patient compliance when nurses perform bowel preparation.