ColoPrep
Project status
Collaborators
Nuzhat Ahmad, MD
Kristi Delp
Bernadette Muccie
Nadim Mahmud, MD, MS, MPH, MSCE
Mary Coniglio, MBA
Innovation leads
Funding
National Center for Advancing Translational Science
Institute for Translational Medicine and Therapeutics
National Institutes of Health
Opportunity
Colorectal cancer (CRC) is the second leading cause of cancer-related deaths among men and women in the United States. It is recommended that individuals begin regular screenings for CRC at the age of 45. Screening can prevent cancer by discovering precancerous polyps that can be removed before they turn into cancer. It can also find CRC early when treatment often leads to a cure. However, various barriers lead to substantial no-shows and cancellations for screenings done through colonoscopy.
Current approaches to increase screening completion are challenging and costly (as in the case of phone calls and patient navigators) or have low patient engagement (as with instructional videos or mobile apps). Poor bowel preparation before colonoscopies is also common.
Intervention
ColoPrep is a bidirectional texting program used by Penn Medicine to connect with colonoscopy patients and help them prepare for upcoming CRC colonoscopy screenings. Patients in the program received automated reminders and instructions via text message one week before their colonoscopy. The texts, delivered through the Way to Health platform, are written in conversational language to engage patients and foster commitment. Patients can also send questions to the service; when a human response is needed, questions are escalated to the care team.
After an initial pilot that suggested the intervention could increase colonoscopy show rates, we conducted clinical trials to test the texting program in larger populations. The first of these trials used a version of ColoPrep with unidirectional texting (patients could not text back) to make it easier to scale, and the second used bidirectional texting.
Impact
The clinical trials showed that ColoPrep with bidirectional texting was linked to significantly higher attendance rates – by 6 percentage points – compared to usual care only, which involves written instructions for colonoscopy prep and a nurse phone call. This increase was also seen among Black patients, a population known to experience disparities in CRC screening and outcomes.
In the trial with unidirectional text messaging, show rates did not change between groups. Bowel preparation quality did not change substantially with either version of ColoPrep.
ColoPrep with bidirectional texting was implemented in 2021 as the standard of care at Penn Medicine Radnor and subsequently scaled to Penn Presbyterian Hospital, Penn Digestive and Liver Health Center University City, Pennsylvania Hospital, and the Perelman Center for Advanced Medicine.
ColoPrep serves over 15,000 patients annually across the downtown Penn Medicine colonoscopy clinics. The rise in show rates could translate to around 1,800 more colonoscopies completed each year across the health system and improved access to this essential procedure.
Way to Health Specs
Learn more about the platformInnovation Methods
Fake back end
Fake back end
For the first phase of the automated texting pilot in colonoscopy preparation, we asked open-ended questions that were answered by a GI fellow. This enabled us to learn more about the needs of patients quickly and at a low cost. It also helped us identify portions of the support process that could be automated.
Fake back end
It is essential to validate feasibility and understand user needs before investing in the design and development of a product or service.
A fake back end is a temporary, usually unsustainable, structure that presents as a real service to users but is not fully developed on the back end.
Fake back ends can help you answer the questions, "What happens if people use this?" and "Does this move the needle?"
As opposed to fake front ends, fake back ends can produce a real outcome for target users on a small scale. For example, suppose you pretend to be the automated back end of a two-way texting service during a pilot. In that case, the user will receive answers from the service, just ones generated by you instead of automation.