Govert Veldhuijzen

15 General introduction, history of patient education in endoscopy, aim and outline information, the American Gastroenterology Nursing Association produced several viewpoint papers on items concerning informed consent and patient education prior to endoscopy. 16,40,41 In the 1990s, the first informative booklet was presented as an intervention; also new was the introduction of the Visual Analogue Scale (VAS) to identify differences in the pain patient experience undergoing gastroscopy. 42 Special attention was also given to preparing children before endoscopy and providing sedation to them during endoscopy, a before derelict field of knowledge. 43,44 These initiatives led to a better understanding by patients of endoscopy. A cohort study from 1991 among 102 patients found that 93% of referred patients for endoscopy understood the indication for their endoscopy and 93% comprehend the procedure itself. 45 Importantly, nurses expressed that patient teaching activities were extremely rewarding for both patient and nurse teachers. 46 Implementing best practices in patient education is paramount; in 1994 the high yield of a regional audit system with proper patient education benchmarks prior to endoscopy was published. 47 A trial, also in 1991, comparing a videotape with a physician explaining informed consent items before endoscopy, showed that 1. the videotape alone was even as good as 2. the video plus physician and better than 3. the physician in person. 48 This stipulates the problem of patient-to-patient variability of information when a single individual must repeat the same message repeatedly. An editorial from 1994 on video education choose almost prophetic words: “As we approach the dawn of the establishment of the information highway, the informed consent process appears to me to be outdated and outmoded …. It would be a simple matter to extend [this videotape] into a videotape that would more fully demonstrate the procedure, including graphs, schematics, and other video wizardry. The next logical extension would be to include an interactive program. This would allow the viewer to actively participate in the learning process.” 18 One year later other authors developed an interactive video disc as suggested. 49 Three years later, in 1998, the first computer assisted concept for explaining information proved useful in an Swiss practice. 50 A 1999 Lancet paper reports a strong decrease in preprocedural anxiety scores when patients were shown a video prior to endoscopy. 51 In 2000 this was also confirmed in a small sample using physiological measures (haematocrit). 52 To help nurse counsellors to reduce anticipatory anxiety, it proved helpful to consider patient demographics, asking about previous experiences with endoscopy, and eliciting special concerns. 53 To this end, a comprehensive instruction program to teach the nurse counsellor was published. 54 In a 1998 study there was specific attention for two main coping styles of patients: information seekers or avoiders. Seekers approach threatening 1