Govert Veldhuijzen

21 General introduction, history of patient education in endoscopy, aim and outline One focus of research in the years 2000 to 2010 dealt mainly with measurements to improve the adherence to colorectal cancer screening programs as these were introduced in several countries around this time. Because this beholds more than the endoscopic procedure alone, with for instance in-depth information on false negative and false positive findings of diagnostic tests. This therefore was beyond the scope of my research. The heterogeneity of the trials in the literature discussed above about interventions and outcome measures precludes proper meta-analysis. In recent years three publications still strived to do so, but they were either limited to assessing effect of education on anxiety alone or focused on bowel preparation scores alone. 14,15,56 Therefore, I summarized all relevant endpoints used in the literature above in table 1. Table 1. Outcome measures in patient education research in endoscopy Outcome measure Scales Year of entry Author 1. Anxiety Likert STAI 1982 1989 Kamakura, Y. et al Levy, N.et al 2. Pain / stress Physiological measures VAS Haematocrit Heart rate Skin conductance S-cortisol levels in saliva 1990 2000 2004 2004 2019 Lanius, M. et al Neumann, J. et al Van Vliet, M. et al Van Vliet, M. et al Volkan, B et al 3. Cost effect n/a 2001 Abuksis, G. et al 4. Satisfaction Willingness to return Likert Likert 2002 2007 Bassi, A. et al Bytzer, P et al 5. Bowel preparation UPAS BBPS OBPS Arondchick 2009 2011 2011 2014 Modi, C. et al Calderwood, A. et al Spiegel, B. et al Hseuh, F. et al 6. Information re-call Validated questionnaire 2015 Cho, Y. et al 7. Adenoma detection rate ADR 2016 Hayat, U. et al 8. Polyp detection rate PDR 2016 Park, J. et al A topical editorial emphasized the “ceiling effect” that is part of these interventions to reach 90% adequate bowel preparation scores in an endoscopy unit. 113 As a result, these interventions will be beneficial in underperforming units with scores well below the 85% benchmark advised by the U.S. Multi-Society Task Force on Colorectal Cancer Screening. 114 By contrast, in better performing units the ceiling effect prevents to detect meaningful differences. 1