NOVEL PATIENT SUPPORT PROGRAMME, INCLUDING ARTIFICIAL INTELLIGENCE ENABLED CHATBOT FOR ENHANCED PATIENT INSTRUCTION IN BOWEL PREPARATION

Aims New ESGE guidelines strongly recommend use of enhanced instructions for patients taking bowel preparation. Technology based patient support programmes (PSP) require minimal clinical resource. We discuss a new method for enhanced instructions through an artificial intelligence enabled chatbot.

Methods A novel, innovative, enhanced PSP, including SMS reminder service, personalised dosing schedules and a chatbot, was launched alongside PLENVU to enhance patient experience during bowel preparation. It aims to ensure optimal adherence and therefore successful bowel preparation. The chatbot uses natural language processing to understand a patient’s question intent and provide the corresponding answer. The chatbot is available at all times to answer questions online. It features videos, hyperlinks and contacts for medical information services. Questions were identified from search engine and medical information records. The chatbot can be accessed through the product website.

Results From October 2018-November 2019, 1743 questions were asked with an average of 2.4 questions per session, from an estimated 35 countries. Of the total patients using the website 33% choose to use the chatbot. The chatbot has identified useful insights into patient concerns and knowledge gaps. The most commonly asked questions are outlined in [Table 1].

Tab. 1 Top 5 questions asked on the chatbot, number of times and response provided.

When will PLENVU start to work?	304/1743	The time PLENVU takes to work varies from person to person. Stay close to a toilet once you start taking PLENVU. If you don’t have a bowel movement within 6 hours of taking PLENVU, stop taking it and contact your doctor immediately.
How do I prepare PLENVU?	161/1743	PLENVU should always be prepared and taken exactly as described in the Patient Information Leaflet, or as your doctor, pharmacist or nurse has told you. Read the Patient Information Leaflet here. Click below to find out more about preparing Dose 1 or preparing Dose 2. [Button 1: Prep Dose 1], [Button 2: Prep Dose 2], [Button 3: Patient Information Leaflet]
How do I prepare PLENVU? What do I do if I cannot complete the whole dose?	105/1743	Try to drink as much of each dose of PLENVU as you can, including at least 500ml of clear fluids after each dose. It may be easier to take if you drink it through a straw or if you refrigerate it once it has been made up. If you are unable to finish the full dose, make a note of how much PLENVU you were able to take, and tell your doctor or nurse before your procedure. Click below to see which clear fluids are recommended.
How long will PLENVU work for?	73/1743	The time PLENVU takes to work varies from person to person. Stay close to a toilet once you start taking PLENVU. If you don´t have a bowel movement within 6 hours of taking PLENVU, stop taking it and contact your doctor immediately.
What clear fluids can I drink?	66/1743	Clear fluids include water, clear soups, herbal tea, black tea or coffee (without milk), soft drinks/diluted cordials (NOT blackcurrant) and clear fruit juices (without pulp). Do not drink alcohol, milk, anything coloured red or purple, or any other drinks containing pulp material.

Conclusions PSP uptake and particularly the chatbot has been promising. A comprehensive patient support programme may ensure consistently high-quality bowel preparation versus traditional instructions. The digital basis of this PSP may limit participation based on access to technology. However, 87.7% of the European population are internet users. It remains important to measure the direct impact of this PSP on bowel preparation outcomes.