Govert Veldhuijzen

17 General introduction, history of patient education in endoscopy, aim and outline high patients satisfaction scores when a counselling visit was offered the evening before endoscopic biliary interventions. 58 A three-armed trial compared different patient routes: 1. a 12-minute nurse counselling session prior to upper endoscopy, 2. cognitive and behavioural interventions like breath exercises and swallowing techniques and 3. a control group with verbal instructions alone. This showed a positive impact of both interventions 1. and 2. compared to controls in 3. on patient distress during endoscopy. 59 A Dutch trial performed by psychologists compared patient coping styles (information seekers versus avoiders). A potential disadvantage was demonstrated, as this study showed that information overload unexpectantly burdens even the information seeking patient as no beneficial effect on anxiety, pain or experience was seen. 60 Information recall improved with a dedicated visit. 61 In most studies patient related outcomes were used to define the effect of the intervention. But in 2009 the first study evaluated an procedural outcome: bowel preparation. 62 This aspect of colonoscopy was often used in trials to compare laxative medication prior to colonoscopy. Several scales were used to define adequate bowel preparation during endoscopy, these are mentioned in table 1. In the 2009 study written information and a physician visit were compared to a short questionnaire identifying knowledge gaps in participants which were subsequently addressed in the same visit. This failed to improve the bowel preparation score on the Universal Preparation Assessment scale (UPAS). One year later, better bowel preparation was seen in inpatient colonoscopies when prior counselling and written instructions were given. 9 A comparative Turkish trial proved the superiority of verbal information to written or no additional information in lowering anxiety, although this might be due to literacy levels as only 55% had secondary or higher educational levels. 63 This finding was also confirmed in a Chinese and Indian cohort. 64,65 In a 2019 Saudi cohort of children undergoing upper endoscopy, the opposite was found after broad verbal explanation. Authors stated that the procedural stress is significantly less, as measured by the s-cortisol levels in saliva and the anxiety questionnaire. 66 In 2019, Australian research matched 76 poorly prepared patients with adequately prepared controls to find specific risk factors -opioid / constipating agents use and low socioeconomic status - for poor bowel preparation. Second, they developed a screening tool to guide the nurse counsellors on the level of education needed. As a result, a 61.6% to 33.5% drop in outpatient visits was achieved after implementation, clearly making more efficient use of education resources in endoscopy. 67 1