Govert Veldhuijzen

18 Chapter 1 The second main direction of research is written information. A wide variety of options in printed materials was studied. A key element is that printed information may or may not be read. In a cohort only 52% of patients referred for endoscopy actually reads the provided text completely. 68 Also the quality and the content of printed information varies considerably. For instance in an Northern Ireland sample of seven hospitals some leaflets even lacked vital information such as optional sedation or risks of endoscopy. 69 Despite these shortcomings, patients were generally satisfied with the information. 70 Several options to provide information have been explored since. Adding written information to oral explanation by a physician yield higher patient satisfaction scores compared to oral explanation alone. 71 In 2010, a general information sheet showed high patient satisfaction rates using the Global Rating Scale (GRS). 72 Written information showed significant decrease of anxiety before endoscopy. 73 Importantly, a Dutch trial showed that coping styles are not relevant when evaluating an information brochure. This did not significantly affect anxiety or satisfaction scores. 74 Adding a leaflet with endoscopic images of an badly prepared colon to explain the rationale of purgative use did not affect bowel preparation, as examined with the Boston Bowel Preparation Score (BBPS). 75 A booklet explaining this same concept by using the metaphor of driving through a snowstorm when advancing through a badly prepared colon did improve the bowel preparation, here examined with the Ottawa Bowel Preparation Score (OBPS). 76 A cartoon depicting a concerned physician when shown a dirty colon in a Korean cohort of patients did improve the bowel preparation scores. 77 An American study on a multilingual (English and Spanish) booklet was published in 2016, showing a beneficial effect of implementation of this strategy when evaluating bowel preparation. 78 Endoscopic tissue sampling is common, but withholds usually around one week waiting time before the pathology report is completed. The effect of specific patient education about endoscopic biopsies reduced the anxiety levels in patients that received biopsies during endoscopy. 79 When more targeted information on the risk to fall after sedation is provided to vulnerable patients in print prior to endoscopy, the adherence to safety instructions rises from 33% to 100%. 80 The third main direction of research after 2000 are audio-visual interventions followed by more sophisticated computer based interventions that finally could be delivered as web based solutions via internet. These were studied exhaustingly and thereby formed the largest body of science. In 2001, the first landmark trial showed that computer- assisted instruction helps physicians meet their duty to inform and to disclose with no decrement to the interpersonal aspects of the patient-physician relationship. 81 Another approach used digital visualization on a bedside laptop as an adjunct to a physician visit. This was timed prior to cardiological and endoscopic examinations in a combined cohort