Govert Veldhuijzen

171 Discussion and future perspectives Motivated to improve the scalability of the hospital based computer assisted instruction, our group published a viewpoint paper. In this chapter 3 we started out with the consensus view that optimal patient education prior to colonoscopy is essential to safeguard the quality of the procedure. As concluded, patients benefit from adequate information regarding laxatives, risks and alternatives. Furthermore, from a medicolegal standpoint, informed consent has to be obtained. 5 Also the endoscopist needs access to patient data prior to the procedure in order to carry out an adequate risk assessment for the use of sedation. This posed challenges in data safety management and communication with the hospital electronic health records. Most endoscopy units in the Netherlands integrated a pre-endoscopy consultation in their clinical care pathways to obtain this mandatory information. This practise has several benefits to maintain quality. But the number of colonoscopies was increasing rapidly as a result of the introduction of the Dutch national screening program for colorectal cancer. Consequently, nurse counselling had become increasingly resource intensive. This was a key driver for innovation of this process. A newly developed web based platform would have to resolve the identified important implementation obstacles. With our developed CAI we seized the opportunity to develop an expanded system that could substitute this hospital based practice and tackle logistical challenges. We explained our proposed new algorithm to educate patients before endoscopy. Chapter 4 described the subsequent development from hospital sited computer assisted instruction – with one-way communication - into computer based education (CBE) at home that allows two-way communication. We outlined the hypothesis of a study protocol to establish the effect on quality of bowel preparation. This multicenter, randomized, endoscopist blinded clinical trial protocol evaluated the primary outcome bowel preparation during colonoscopy. The secondary outcome measures were sickness absence, patient anxiety after instruction and prior to colonoscopy, patient satisfaction and information re-call. We also evaluated patient consumption of additional consultation time (by phone or visit) in the CBE group. We therefore included validated questionnaires for eHealth literacy, health-related quality of life and patient activation measure, as well as a patient reported productivity tool. Patient were recruited in four endoscopy units of different levels (rural, urban, and tertiary). The inclusion criteria were adult age and referral for complete colonoscopy. Exclusion criteria were Dutch illiteracy, audio-visual handicaps or mental disabilities and no (peers with) internet access. The intention was to evaluate online computer-based education as tool for patient education prior to a colonoscopy. By choosing a direct comparison 9