Govert Veldhuijzen

13 General introduction, history of patient education in endoscopy, aim and outline questions. 17 It is the responsibility of the endoscopist to discuss this with the patient and to document this prior to every procedure. 18 Due to the invasive character colonoscopy is associated with patient reported outcomes like embarrassment, pain and discomfort. 19 Sedatives to relieve anxiety is the method of choice used in order to mitigate discomfort patients experience during colonoscopy. 20 In addition to optimal patient education and obtaining informed consent, the routine use of sedative and analgesics requires a risk assessment of the individual patient. 20,21 This warrants more than just sending an invitational appointment letter to the patient before endoscopy. The effect of any information transfer is influenced by patient dependent factors such as educational level, comprehensive capacities, and cultural aspects. 22 This results in a mixed understanding of the information that can negatively affect compliance to instructions. 23 Many hospitals rely on personal counselling by nurses or doctors to resolve this issue and at the same time obtain informed consent prior to the procedure. This leads to improved adherence to the instructions for bowel preparation. 24 Whilst effective, it is time-consuming for the counsellor, repetitive, and can result in variability in information distributed to patients. More importantly, it demands an extra hospital visit for the patient that implicates travelling costs and taking a leave absence from work. 25 Derived from these factors, it is associated with costs for the endoscopy unit (nurse wages), the patient (travel costs) and society (leave absence from work). These elements are relevant to patient education. For a full overview of the topic I start with the historical development of patient education in endoscopy and describe the lessons learned. Shortly I will explain the concept of eHealth and discuss where these two entities meet. Then I conclude this introduction by stating the starting points of the research we conducted in this thesis. HISTORICAL OVERVIEW OF PREPARING PATIENTS FOR ENDOSCOPY To get insight in the historical development of a medical topic it is useful to check the PubMed “results by year” interface and obtain a tally of the number of hits. Using the term “patient education endoscopy” renders 1035 hits in total (June 2020), but just a handful in the 1980s and 1990s. In this overview I mainly report on articles regarding use of endoscopy in gastroenterology. The following paragraphs describe the insights from literature in chronological order up to the 2000s. This preliminary work set the stage for thinking about patient education 1