Govert Veldhuijzen

16 Chapter 1 situations by intellectualization and by seeking information to make events more predictable, whereas “avoiders” use defensive mechanisms of avoidance and denial, preferring the event to remain unpredictable. When information seekers were given additional sensory information (what the patient was likely to see, hear, or feel during each stage of the procedure) there was a reduction of anxiety, recovery time, and observed behavioural indices of pain of colonoscopy. But there was no effect seen on sedation dose or patient perception of pain. Avoiders on the other hand scored higher satisfaction rates when just procedural information (facts) were presented. 55 Overview 2000-2020, ‘research along three different lines’ From the 2000s onwards, there still was wide variety in Europe in how patient education to obtain informed consent was embedded in endoscopy. 56 So the research continued on this topic, spreading out in three main directions: 1. nurse counsellors, 2. written materials and 3. audio-visual guided strategies. (Figure 1.) Figure 1. Research directions before and after the millennium A noteworthy publication in the first group concerning research on nurse counselling was a 2001 cost effectiveness trial. Nurse counselling prior to endoscopy showed to be cost effective because it reduced the need for repeat procedures after initially failed attempts due to poorly cleansed colons. 24 For patients who poorly tolerated endoscopy, a counselling session by a surgeon and psychiatrists reduced the need for midazolam given during the subsequent endoscopy. 57 In 2003 endoscopists in Thailand established