Govert Veldhuijzen

19 General introduction, history of patient education in endoscopy, aim and outline of patients. This study showed an increase of satisfaction and level of knowledge of the patients, scored by a ten-item questionnaire, without significant consuming more time. 82 Allowing room for choice for patients to see an instructive video showed no significant improvement in patient satisfaction; the authors therefore suggest to fully implement video education if available. 83 However, Danish investigators reported no effect of a thorough video information module on improving anxiety, pain, tolerability or willingness to return for repeat colonoscopy. 84 The reason why their trial was negative compared according to the authors in comparison to earlier trials centred on the inability to tailor this modality to the individual patient. The first video based intervention in patient education that showed improvement in bowel preparation as main outcome was published in 2013 and was reconfirmed in 2014. 85,86 The first internet based delivery of video content was investigated in a trial where only 6% of the patients actually watched the video. 87 The apparently main stumble block was the fact that patients received a paper card with the website address and the instruction “go to this website”. This turned out not to motivate patients to visit the website. Nevertheless the message “online education does not work” did reverberate in a subsequent editorial referring to this trial. 88 No less than three subsequent letters to the editor discussed this further. Authors highlighted several important issues such as technical accessibility of the video, the importance of adequate health and digital literacy and the interesting point that computer based interventions “will become more successful over time as successive generations become computer savvy at younger ages”. 89-91 A Chinese paper in 2014 compared a telephone-based re-education the day before colonoscopy as an add-on to nurse counselling, with superior bowel preparation scores as a result. 92 The impact of this unsophisticated form of telemedicine and the concerns of effectiveness in real life settings led to discussion whether the results would be representative in the Western world. 93 The link between good information re-call and subsequent better bowel preparation was demonstrated in a Korean cohort, where a video intervention proved superior in both outcomes. 94 Also in Korea, the first trial utilizing short message service (SMS) was performed, yielding better bowel preparation scores than controls. Most interestingly, these authors added a third arm to SMS and controls utilizing telephone calls, with comparable results, leading to the conclusion that SMS could be just as effective, but cheaper and therefore the preferred option. 95 The last paper to date on an SMS based reinforced education intervention in Germany showed significantly higher bowel preparation scores, leading to improved adenoma detection rate. 96 1