Combining Science with Art to Educate and Motivate Patients Prior to Colorectal Cancer Screening

  • Piet C. de GroenEmail author
  • Shreepali Patel
  • Mariana Lopez
  • Michael Szewczynski
  • Rob Toulson
Conference paper
Part of the Smart Innovation, Systems and Technologies book series (SIST, volume 59)


Colorectal cancer (CRC) is the second leading cause of cancer deaths in the US despite wide use of colonoscopy to prevent CRC and CRC-related mortality. Colonoscopy is used to identify and remove lesions that will lead to cancer, however, most deaths occur because lesions are not detected or completely removed during the procedure. Patients play a crucial role in the detection component of colonoscopy: the better the colon is prepared, the higher the chance of detection of all polyps and cancers. In general, patients are instructed to clean the colon by way of a paper or web-based form that lists the objective (scientific) steps involved; unfortunately this too often does not result in a well-prepared colon. Behavior is known to be heavily influenced by emotion. As the first phase of a smart education research project we created an artistic and instructional documentary in which patients engage with the educational content through emotional responses; i.e., we motivate patients to follow instructions by combining scientific with emotional aspects of CRC prevention including preparation of the colon prior to colonoscopy. In the second research phase we will test whether use of the documentary results in improved colon preparation.


Colonoscopy Colorectal cancer Emotion Film Audiovisual Education 



This project was supported by Mayo Clinic, Anglia Ruskin University and the Mayo Clinic Slaggie Cancer Patient Education Fund.


  1. 1.
    Siegel, R.L., Miller, K.D., Jemal, A.: Cancer statistics, 2016. CA Cancer J. Clin. 66, 7–30 (2016)CrossRefGoogle Scholar
  2. 2.
    Xirasagar, S., Li, Y.J., Hurley, T.G., Tsai, M.H., Hardin, J.W., Hurley, D.M., Hebert, J.R., de Groen, P.C.: Colorectal cancer prevention by an optimized colonoscopy protocol in routine practice. Int. J. Cancer. J. I. du Cancer (2014)Google Scholar
  3. 3.
    Corley, D.A., Jensen, C.D., Marks, A.R., Zhao, W.K., Lee, J.K., Doubeni, C.A., Zauber, A.G., de Boer, J., Fireman, B.H., Schottinger, J.E., Quinn, V.P., Ghai, N.R., Levin, T.R., Quesenberry, C.P.: Adenoma detection rate and risk of colorectal cancer and death. N. Engl. J. Med. 370, 1298–1306 (2014)CrossRefGoogle Scholar
  4. 4.
    de Groen, P.C.: Advanced systems to assess colonoscopy. Gastrointest. Endosc. Clin. N. Am. 20, 699–716 (2010)CrossRefGoogle Scholar
  5. 5.
    Oh, J., Hwang, S., Cao, Y., Tavanapong, W., Liu, D., Wong, J., de Groen, P.C.: Measuring objective quality of colonoscopy. IEEE Trans. Bio-Med. Eng. 56, 2190–2196 (2009)CrossRefGoogle Scholar
  6. 6.
    Muthukudage, J., Oh, J., Tavanapong, W., Wong, J., De Groen, P.C.: Color based stool region detection in colonoscopy videos for quality measurements. In: Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), LNCS, vol. 7087, pp. 61–72 (2011)Google Scholar
  7. 7.
    Rex, D.K., Petrini, J.L., Baron, T.H., Chak, A., Cohen, J., Deal, S.E., Hoffman, B., Jacobson, B.C., Mergener, K., Petersen, B.T., Safdi, M.A., Faigel, D.O., Pike, I.M., ASGE/ACG Taskforce on Quality in Endoscopy: Quality indicators for colonoscopy. Am. J. Gastroenterol. 101, 873–85 (2006)Google Scholar
  8. 8.
    Boroff, E., Crowell, M., Leighton, J., Faigel, D., Gurudu, S., Ramirez, F.: The relationship between withdrawal time and intubation time in colonoscopy: correlation with adenoma detection rate (ADR). Am. J. Gastroenterol. 107, s806–s807 (2012)Google Scholar
  9. 9.
    Johnson, D.A., Barkun, A.N., Cohen, L.B., Dominitz, J.A., Kaltenbach, T., Martel, M., Robertson, D.J., Richard Boland, C., Giardello, F.M., Lieberman, D.A., Levin, T.R., Rex, D.K.: Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US Multi-Society Task Force on Colorectal Cancer. Am. J. Gastroenterol. 109, 1528–1545 (2014)Google Scholar
  10. 10.
    Abuksis, G., Mor, M., Segal, N., Shemesh, I., Morad, I., Plaut, S., Weiss, E., Sulkes, J., Fraser, G., Niv, Y.: A patient education program is cost-effective for preventing failure of endoscopic procedures in a gastroenterology department. Am. J. Gastroenterol. 96, 1786–1790 (2001)CrossRefGoogle Scholar
  11. 11.
    Liu, X., Luo, H., Zhang, L., Leung, F.W., Liu, Z., Wang, X., Huang, R., Hui, N., Wu, K., Fan, D., Pan, Y., Guo, X.: Telephone-based re-education on the day before colonoscopy improves the quality of bowel preparation and the polyp detection rate: a prospective, colonoscopist-blinded, randomised, controlled study. Gut (2013)Google Scholar
  12. 12.
    Taylor, J.S.: Learning with emotion: a powerful and effective pedagogical technique. Acad. Med.: J. Assoc. Am. Med. Coll. 85, 1110 (2010)CrossRefGoogle Scholar
  13. 13.
    Patel, S., Toulson, R.: Educating and enhancing compassion, emotion and reflective professional practice through contemporary digital filmmaking. In: Smart Digital Futures, vol. 262, pp. 582–591. IOS Press (2014)Google Scholar
  14. 14.
    Patel, S.: The Golden Window. Eyeline Films (2013)Google Scholar
  15. 15.
    Gupta, R., Brownlow, B., Domnick, R., Harewood, G., Steinbach, M., Kumar, V., de Groen, P.: Colon cancer not prevented by colonoscopy. Am. J. Gastroenterol. 103, S551–S552 (2008)CrossRefGoogle Scholar
  16. 16.
    Bakken, J., van Leerdam, M., Enders, F., Tavanapong, W., Oh, J., Wong, J., de Groen, P.: Colonoscopy peer review utilizing automated video capture. Am. J. Gastroenterol. 104, 1391 (2009)Google Scholar
  17. 17.
    Rosenfeld, G., Krygier, D., Enns, R.A., Singham, J., Wiesinger, H., Bressler, B.: The impact of patient education on the quality of inpatient bowel preparation for colonoscopy. Can. J. Gastroenterol. = Journal canadien de gastroenterologie 24, 543–546 (2010)CrossRefGoogle Scholar
  18. 18.
    Kakkar, A., Jacobson, B.C.: Failure of an internet-based health care intervention for colonoscopy preparation: a caveat for investigators. JAMA Intern. Med. Online first (2013)Google Scholar
  19. 19.
    Kang, X., Zhao, L., Leung, F., Luo, H., Wang, L., Wu, J., Guo, X., Wang, X., Zhang, L., Hui, N., Tao, Q., Jia, H., Liu, Z., Chen, Z., Liu, J., Wu, K., Fan, D., Pan, Y.: Delivery of instructions via mobile social media app increases quality of bowel preparation. Clin. Gastroenterol. Hepatol.: Official Clin. Pract. J. Am. Gastroenterol. Assoc. (2015)Google Scholar
  20. 20.
    Kuruvilla, C.: Minnesota takes aim at colon cancer with cheeky new ad campaign. (2013). Accessed 18 Jan 2016
  21. 21.
    Butterly, L.: Preparing for a Colonoscopy. (2010). Accessed 18 Jan 2016
  22. 22.
    Couric, K.: Katie Couric’s Colonoscopy Prep. (2011). Accessed 18 Jan 2016
  23. 23.
    Galati, J.: Colonoscopy Bowel Prep: what a bad one looks like. (2012). Accessed 18 Jan 2016
  24. 24.
    Staff, I.C.: Colorectal cancer rates higher for Minnesota’s Natives. (2007). Accessed 18 Jan 2016
  25. 25.
    Barry, D.: Dave Barry: a journey into my colon—and yours. (2009). Accessed 18 Jan 2016
  26. 26.
    Decety, J., Jackson, P.L.: The functional architecture of human empathy. Behav. Cogn. Neurosci. Rev. 3, 71–100 (2004)CrossRefGoogle Scholar
  27. 27.
    Cram, P., Fendrick, A.M., Inadomi, J., Cowen, M.E., Carpenter, D., Vijan, S.: The impact of a celebrity promotional campaign on the use of colon cancer screening: the Katie Couric effect. Arch. Intern. Med. 163, 1601–1605 (2003)CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Piet C. de Groen
    • 1
    Email author
  • Shreepali Patel
    • 2
  • Mariana Lopez
    • 3
  • Michael Szewczynski
    • 1
  • Rob Toulson
    • 3
  1. 1.Mayo ClinicRochesterUSA
  2. 2.Cambridge School of ArtAnglia Ruskin UniversityCambridgeUK
  3. 3.CoDE Research InstituteAnglia Ruskin UniversityCambridgeUK

Personalised recommendations