S624 A Picture Is Worth a Thousand Words—Using Cartoons Instead of Text to Improve Colonoscopy Bowel Prep

Introduction: Bowel prep adequacy is critical for effective colon cancer screening but up to 25% of patients have inadequate preps. Patients at our institution, as well as most others, typically receive text-based, electronic, or printed instructions for colonoscopy. Studies show that a carefully structured use of images improves comprehension, adherence to medical treatment, and engagement. In this study, we partnered with patients to assess the clarity and limitations of text-based instructions and developed cartoon-based bowel prep instructions, aiming to improve bowel prep quality. Methods: In the pilot study, 108 patients at an academic hospital-based endoscopy unit from June to July 2024, undergoing colonoscopy prep with the text-based prep instructions, completed a survey on their understanding and clarity of the instructions. About 40% of respondents favored pictorial instructions. Subsequently, we developed a cartoon detailing bowel prep instructions, using feedback from patients, endoscopy nurses, and schedulers. The limited text within cartoons was also translated into Spanish based on patients’ preferences. The cartoon-based instructions, along with concise written instructions, were made available via link, email or paper handout. After 4 months to allow for proper implementation of the new instructions, we conducted a retrospective study to compare the pre- and post-intervention cohorts. The primary outcome was the rate of inadequate prep. Results: The average age in pre-intervention and post-intervention cohorts was similar, 57 years old and 55 years old, respectively. We also assessed common risk factors such as hypertension, diabetes/prediabetes, and obesity, which were similar in both cohorts. Antipsychotic and GLP-1 use was higher in the pre-intervention cohort. Opioid use was low, with 2 patients in each cohort. In the pre-intervention cohort, 6/60(10%) patients had inadequate prep. In the post-intervention cohort, 4/60 (6.67%) patients had inadequate prep (P = 0.26). Conclusion: In this study, we designed the first fully cartoon-based bowel prep instructions, incorporating patient and provider preferences. By improving understanding of bowel prep and addressing patients’ needs, we had a relative risk reduction of inadequate prep of 33.3%. A larger sample size and broader implementation in other endoscopy units will help determine if pictorial instructions can complement or replace traditional text-based instructions and improve rates of colon cancer prevention.