Govert Veldhuijzen

78 Chapter 4 The pilot study did not find significant differences, so a non-inferiority design is chosen. If this intervention proves to be non-inferior, the operational advantages of counselling at home (reducing personnel and facility costs) still outweigh the investment for endoscopy units. There might be potential gain in the patient related outcome measures like anxiety and satisfaction. For generalization purposes it is of great importance to acquire a large heterogeneous sample that is representative for all patients in a (Western) endoscopy unit. By using four endoscopy units in several Dutch provinces (based in rural, urban and academic hospitals) the aim is to optimize diversity. Possible influences educating patients are health literacy, educational level and the time between education and the procedure. When the intervention was designed, the perspective from patient panels, nurses and doctors were all incorporated. Lessons learned in other best practices, such as 3D visualization, were implemented. This takes into account the possibility of variation in learning styles between individuals and increases the potential for acquisition and retention of knowledge. The use of voice-over in adjunction to video accommodates patients with low literacy levels. From the elderly user perspective, easily accessible program features are added, such as optionally enlarged fonts and utilizing touch screen. Unlimited access to the information is guaranteed though a re-usable web-based link, so patients are enabled to view their CBE on-demand. Finally, language barriers are easily overcome with the availability in the menu to choose the language. The double-check of information derived from the questionnaire also reinforces patients to important constructs of information provided earlier. Although guided by logical transitions at first time viewing, user control over the program sequence for repeated learning is allowed. Before the implementation, there was a careful analysis performed to provide a seamless integration of the CBE in the current endoscopy unit process. A multicenter trial in real life setting has barriers for inclusion. For the clinically gathered questionnaires the usual contact moments were chosen to hand out questionnaires by the endoscopy unit operational staff. Missing questionnaires can be the result. Nevertheless, this trial aims to collect all relevant information at all time points. Patients are eligible for the trial and can operate the CBE even with very basic computer skills. But in the lowest literacy category, it is not possible to test the hypotheses. As of this, it is important to maintain the possibility of face-to-face patient education in the route towards the endoscopy suite for this group. As the future will provide more challenges in patient education, more research in this field is important. The method presented is suitable for evaluating the use of CBE in other endoscopic procedures, as well as in other departments.