Govert Veldhuijzen

14 Chapter 1 in endoscopy. From 2000 onward, I present the body of research on three types of interventions on patient education. I sought to outline how research in patient education in endoscopy evolved with respect to the following elements: determining patient reported and procedural outcomes, informed consent and the design of interventions to improve education. Overview 1979 – 2000, ‘preliminary work’ The first publication on patient education prior to upper gastrointestinal endoscopy was published in 1979 in Japanese literature. This article focused on advice from nursing staff to influence the psychological state of the patient. 26 Soon, more publications followed in 1981, outlining the important role of education of patients before endoscopy from a psychological perspective too. 27,28 Even in those years, the concept of using endoscopic colour video’s to enhance the information content of the instruction was already utilized in urological endoscopy. 29 The first paper on the need for proper education prior to upper gastrointestinal endoscopy that used patient reported data, was published in 1982. 30 In the same year, a study examined an educational tool (a pamphlet) to alleviate anxiety before endoscopy. 31 Here, for the first time, a patient related outcome – anxiety - for these types of studies was introduced. This acknowledged that patient anxiety can be a relevant problem. In 1985, two German authors recognized the need to obtain informed consent and organize pre- and post-endoscopy care. 32,33 In the following year, several publications addressed the need to explain the risk of complications (e.g. perforation) as a responsibility of the endoscopist with special attention for the needs of elderly patients. 34,35 Also, the role of nurses came into focus with respect to informing the patient but also to obtain informed consent. 36,37 Indeed, the literature from the 1980s indicated the need for a structured pre-endoscopy patient education counselling session, with several key ingredients: informed consent, addressing patient anxiety, information about complications and special care for the elderly patient. Subsequent efforts led to the design of an educational intervention trial with four comparative arms. The aim of this 1989 study was to reduce the anxiety level prior to upper endoscopy. 38 This ranged from explaining the procedure by 1. the referring physician, 2. an endoscopist, 3. using photos of every step of the procedure or 4. a video of the procedure. Most interestingly, the authors used the State-and-Trait Anxiety Inventory validated tool to more objectively establish the effect of their intervention on this measure. 39 They found no difference between groups, concluding that “more effective means are needed to accomplish this objective”. 38 On the basis of this