Govert Veldhuijzen

178 Chapter 9 A main limitation was the much lower survey response rate in our study then in the original study, 21.3% compared to 86.2%. This might have been influenced by e-mailing the D-GESQ 30 days after endoscopy, although this time window enables to screen for early to mid-term complications after endoscopy. This might have caused some recall bias. The response rate would have been higher when a patient would have filled out the questionnaire on the hospital bed. Benzodiazepines however causes an euphoric state on the day after endoscopy, which could lead to overestimation of satisfaction. 17 Unfortunately, the appropriate timing for questionnaires after endoscopy has not been determined. 18 We strived to lower the threshold to start and complete the questionnaire so that selection bias would be reduced. But although the most cost effective option, e-mail does not yield the best response rate, in comparison with mail or telephone. 19 We summarized the main findings, implications and limitations of the research in this thesis below in table 1. CAI: computer assisted instruction. CBE: computer based education. STAI: State-and- Trait Anxiety Inventory. NRS: Numeric Rating Scale. NPS: Net promoter score. WTR: Willingness to return. Table 1. Main findings, implications and limitations of this thesis Chapter Main findings Implications Limitations 2. Computer assisted instruction (CAI) before colonoscopy is feasible and yields adequate bowel preparation scores when used as patient education prior to colonoscopy at the outpatient’s clinic Use of 3D visualization and video prior to colonoscopy, in an in-hospital setting, is a useful adjunct to nurse counselling Non-randomised protocol 60% reporting on main outcome 3. After rudimentary experiences, the CAI is suitable for implementation outside the first trial site Serval important implementation obstacles are identified More patients can benefit from this type of education Obstacles for scalability are identified and mostly removed Narrative report Non systematic approach to literature 4. With an algorithm embedded in software, the CAI can be upgraded to a CBE for more effective use from both patient and hospital perspective CBE at home has the potential to substitute a nurse counselling visit with several advantages Only applicable in eHealth literate patients (e.g. with e-mail address) Requires investment from endoscopy units