Govert Veldhuijzen

40 Chapter 2 PATIENTS/MATERIAL AND METHODS We used a prospective, single center, endoscopist blinded, controlled design to conduct our pilot study. Patients Consecutive patients older than 18 years referred for elective colonoscopy were included from March 2013 until November 2013 in a single, large volume endoscopy center (over 4000 colonoscopies/year) in the upper Amsterdam Area in the Netherlands. Exclusion criteria were illiteracy in Dutch and significant audio-visual/mental handicaps. Patients were prescribed the same split dose preparation regime of picosulfate sodium and low fibre dietary advice in the days preceding the colonoscopy. Study design After informed consent was obtained, patients were divided in two groups: the control group received nurse counselling and the intervention group received computer assisted instruction (CAI). We administered three patient questionnaires at three time points. (See the flowchart in figure 1.) In the first questionnaire, patients reported their baseline characteristics regarding age, gender, educational level, ethnicity, use of drugs, number of recent physician visits and experience in multimedia and internet access. Patients rated comfort (“How do you feel after the received information?”) and anxiety (“How anxious are you”) on a 5-point Likert scale (T1). Subsequently the CAI group had a contact with a trained endoscopy nurse for practical matters like bridging in anticoagulant therapy, insulin dosage calculation and scheduling of the colonoscopy. In addition, we also provided a unique hyperlink to the CAI with unlimited access. Next, patients were scheduled for colonoscopy, maximum 6 weeks after the counselling session. After check-in at the endoscopy unit in the hour prior to colonoscopy patients rated comfort and anxiety. Additionally, patient’s knowledge and comprehension were tested in a 10-question survey on the provided counselling information (T2). Within two hours post-colonoscopy, patient’s comfort was again scored on the 5-point Likert scale (T3). During colonoscopy, the endoscopist assessed bowel cleanliness with the Boston Bowel Preparation Scale (BBPS); a cumulative score of three bowel segments, ranging from 0-1 “unsatisfactory”, 2-3 “poor”, 4-5 “fair”, 6-7 “good”, 8-9 “excellent”. 17 To detect subtle differences we applied the Ottawa Bowel Preparation Scale (OBPS). This scale is based on the combination of the cumulative scores of three bowel segments (0 “excellent”, 1 “good”, 2 “fair”, 3 “poor”, 4 “inadequate”), with added points for the amount of residual fluid (0 “none”, 1 “moderate” and 2 “large”). 18