Govert Veldhuijzen

20 Chapter 1 An elaborate study protocol with the aim to implement evidence based practices to organize endoscopy departments in six units in the United States was published in 2015. 97 They studied very clear cut questions on “what works (intervention effectiveness), for whom it works (influence of Medicaid versus other health insurances), in which contexts it works (setting characteristics that influence implementation), and how it works best (comparison of implementation strategies)” However, for undisclosed reasons, the results remain unpublished until date. In 2016, a link to a video placed on YouTube was e-mailed to patients, concerning dietary advice alone prior to colonoscopy. This did not affect the bowel preparation. 98 Another study showed that with a website based video available to all patients, approximately 50% of patients studied this material. 99 Bowel preparation scores were higher in this group. This trial included the ADR as a novel measure, but this outcome was not improved in the intervention group. Watching a video in the hospital directly after a visit to the outpatients clinic improved bowel preparation. 100 Another trial in Korea on access to video material on the day before colonoscopy confirmed improvement of bowel preparation. Here, this did not lead to a higher polyp detection rate. 101 A 2020 paper on the quality of colonoscopy videos on YouTube demonstrated overall poor quality, except for videos produced by professional societies. 102 In Taiwan in 2016, data on the use of CD-ROM with interactive patient education material were published, with significant impact on pain and anxiety. 103 A Chinese application with interactive information, send via a social media app (WeChat) to patients before colonoscopy resulted in improved scores of adequate bowel cleanliness (82.2% vs 69.5%). 104 This platform offered the additional opportunity to ask questions used by 11.3% of the patients. Two more recent studies confirmed the positive effect on bowel preparation of using the same social media app. 105,106 , Comparable results were reported by using an application in Korea 107 Also in Asia, requesting patients to watch a video and re-tell it in their own words, proved a successful strategy to improve bowel preparation. 108 Website information is widely accessible by patients, but the quality is often poor, as found in this 2018 paper. 109 In a low literate group of patients from Philadelphia, USA, a comparative trial with video on colonoscopy preparations showed a dramatic improvement of the rate of adequate bowel preparation. This suggests using video is more appropriate than written materials in illiteracy. 110 In 2018, a paper on a web-based multimedia platform showed both reduction of anxiety and increased information re-call compared to controls. 111 This finding was confirmed with the use of video instruction prior to endoscopic retrograde cholangiopancreatography (ERCP), with higher comprehension of ERCP-related complications and its incidence, leading to higher satisfaction with informed consent process and fewer need for additional explanations. 112