Govert Veldhuijzen

46 Chapter 2 CAI empowers the patient in place, pace and moment of learning, known to have impact on patients satisfaction. 22 In addition, reviewing and sharing online information with relatives is comfortably facilitated. In our trial, some patients viewed the CAI up to six or seven times after providing the secured unique patient hyperlink (data not shown). It is tempting to believe that this contributes to higher grades of comfort before colonoscopy using CAI. Familiarity with the use of computers, notably by elderly patients, could be of concern. In our cohort, 40% in the CAI group were older than 65 years. We did not find an age dependent effect (data not shown). However, before drawing general conclusions from our results, we need to confirm this in larger studies. Nurse counselling certainly provides personal contact and offers emotional support. Indeed, we observed higher comfort scores immediately after nurse counselling compared to CAI. On the other hand, limitations of this human factor in transferring information include distraction from the content, nuisances in the interpersonal domain and the non-uniformity when different nurses or physicians are involved. Limitations A limitation of the present study is its non-randomized design. This was due to the unavailability of the CAI at the start of patient inclusion. However, this design did not affect the scoring by the endoscopist as he/she was unaware of this information and therefore unaware of assignment over the groups whilst assessing the primary endpoint. The endoscopist scoring rate of 60% is most probably due to the limited administrative time in daily practice. Also, the use of patient reported questionnaires restricts medical data collection as compared to chart review. Therefore, we cannot exclude the possibility of selection bias (such as previous experience with colonoscopy) in assessing secondary endpoints. We conclude that implementing CAI leads to a properly cleaned colon at colonoscopy, with a positive impact on the patient-experience. Given the above results, this impact may be further augmented when combining the practical side of CAI with the option of a personalized nurse contact. Computer aided representation of the patients’ journey through the medical landscape will require constant feedback and further research should include updates of the current CAI. The use of a larger randomized controlled multicenter trial design with these added elements might also show non-inferiority and cost-effectiveness of such approach. Macro-economic effects of less short absence sick leave might also be interesting.