Govert Veldhuijzen

39 CAI before colonoscopy is as effective as nurse counselling, a clinical pilot trial INTRODUCTION Colonoscopy is the golden standard of diagnosing, surveillance and removal of precancerous lesions like adenoma in the colon which reduces colorectal cancer mortality. 1 The importance herein is well advocated. 2 On the other hand, the prospect of undergoing colonoscopy and the intensive preparation might have a negative effect on patient’s comfort and anxiety. 3 Adequate bowel preparation is crucial, so it is paramount to optimally inform and instruct our patients prior to a colonoscopy. 4 Poorly prepared colons lead to a higher miss-rate of neoplasms, 5 more complications and increase need for repeat examinations with increased costs and cumulative discomfort for patients. 6,7 Therefore, to achieve adequate bowel cleanliness, patients have to adhere to prescribed use of laxative agents and dietary instructions. 8 Patients cleansing scores are influenced by ASA status, co- morbidity, treatment with gut motility modifying drugs. In our study, where these factors were unaffected by the intervention, we did not evaluate these further. Patient education is obviously of key importance in achieving a well prepared colon. Several educational tools are known to be effective in various degrees; e.g. informative leaflets, cartoons, video and dedicated counselling sessions by a nurse or a physician. 3,9-13 Better education overall establishes higher quality of bowel preparation. 14 In the Netherlands the most common strategy is to provide a nurse counselling session prior to endoscopy. In recent years, advances in internet technology provide us with novel, web-based education programmes, enabling us to combine the previously mentioned modalities. Computer assisted instruction (CAI), available on desktop and smartphone, helps to raise patient satisfaction about the information provided. 15 Proper implementation, however, is important. 16 The evidence base that support use of CAI for bowel preparation is lacking. We hypothesise that CAI using video and 3D animations maximizes effectiveness of nurse counselling and therefore improves bowel cleanliness. Furthermore, CAI will positively influence the patient experience. We conducted a pilot trial assessing the effectiveness of CAI for patient education prior to colonoscopy measuring bowel cleanliness and patient comfort and anxiety. 2