Govert Veldhuijzen

179 Discussion and future perspectives Table 1. Continued. Chapter Main findings Implications Limitations 5. CBE is non-inferior in bowel preparation quality to nurse counselling CBE reduces outpatients’ visits CBE does not affect anxiety, satisfaction or information re-call of patients CBE is an efficient educational tool informing patients before colonoscopy at home and can be applied in routine clinical practice. Use of patient reported data No positive effect on anxiety or other secondary outcomes 6. From patient, hospital and societal view, CBE reduces costs Full implementation of this modality will free up valuable health care resources No real world data 7. The use of (Virtual Reality) VR glasses feasible to relieve pain and discomfort in patients during colonoscopy Future studies are justified to evaluate the possible substitution of sedation with VR. Patients reported that the VR experience was pleasant and distracting, facilitating recruitment for these trials. Small pilot study No reduction of pain or increase in satisfaction established due to sample size 8. D-GESQ has high validity for measuring patient satisfaction D-GESQ can be used for routine use in daily clinical practice to improve quality of patient care in daily endoscopic practice Low response rate 21.8% Single center validation REFLECTION In this PhD thesis, I served as a nexus between software entrepreneurs, endoscopy units and patients. I found that matching expectations between these partners is crucial to succeed in this endeavour. In the more personal domain, it proved paramount to match expectations in the years that my clinical training as an endoscopist and gastroenterologist went hand in hand with deadlines for manuscripts, running and finalizing the multicenter randomized controlled trial and guiding the students contributing to this thesis. One could conclude that the inspiration for writing this thesis was the concept of business provided interventions that I tried to evaluate following the rigor of evidence based medicine. The most challenging task I experienced as a PhD candidate was recruiting the trial sites and subsequently implementing both the CBE platform as well as managing the distribution of questionnaires in daily practice. Fortunately, I could 9