Govert Veldhuijzen

24 Chapter 1 the viewers’ attention while adequately informing him/her of objectives for medical procedures. 96,104,107 Written and spoken in comprehensible language in logical order will enable patients to understand the information. 109 Working together with patient panels improves comprehensibility and acceptability of materials. 119 II. What is the most optimal strategy to deliver patient education to the patient? As learned from earlier research, the access route to the platform should be as convenient as possible. Earlier studies with downloadable apps or referring to website information reaches only a low percentage of patients. 87 To enable accessibility from every browser, a web based HTML 5 scripted interactive website should be developed. Use of HTML5 code enables the use on desktop, smartphone and tablets. Making the patient open the website and read the information is crucial. An option to achieve this is to implement a visit to this website as a mandatory step into the process of the endoscopy unit invitation, for instance by sending out e-mails or utilizing patient portals. Crucial element in patient participation is the obligation to complete the eHealth intervention before getting their colonoscopy appointment date. III. What are clinically relevant outcomes for these trials? Table 1. leads to identification of the key motives that drive this field of science. We could pinpoint three reasons: improving the quality of colonoscopy, optimizing the patient experience and cost control. The quality of bowel preparation in most recent publications was chosen as main outcome measure; most used is the Boston Bowel preparation score, due to the clinical relevance. 96,105,107,110 Several trials added the polyp or ADR to the bowel preparation score. But the value of ADR beyond bowel preparation scores is not evidently clear. 15,99,101 To optimize patient experience, several aspects of patient related outcomes are relevant. Lowering the patient anxiety levels during endoscopy is the most evaluated goal. 56 Furthermore, improving patient satisfaction, often defined as ‘willingness to return’ is a relevant outcome measure. 129 Physiological measures of stress are seldom used and therefore not implemented in this thesis. 52,66 In literature, the effect of interventions on costs was not often presented. 24 As an important factor in our Dutch health system, we set out to perform this relevant evaluation.