E-Patient Counseling trial

BACKGROUND
Patient education prior to colonoscopy has become more complex. Current common practice is nurse counselling, which improves adherence to instructions for bowel preparation. This is costly and has disadvantages regarding uniformity and time consumption for both patient and the hospital. We hypothesized that computer based instruction supported by video and 3D animations can replace nurse counselling in most cases, without losing quality of bowel cleanliness during colonoscopy.

METHODS/DESIGN
We choose a randomized controlled trial design, endoscopist blinded, to evaluate our primary outcome measure cleanliness of the bowels during colonoscopy. Secondary outcome measures were patient anxiety after instruction and prior to colonoscopy, patient satisfaction and cost effectiveness.



We used head-to-head randomization in three endoscopy units, including different levels (rural, urban, tertiary). Inclusion criteria were adult age and referral for complete colonoscopy. Exclusion criteria were Dutch illiteracy, audiovisual or mental handicaps.

Power calculation was performed, based on a non-inferiory calculation of clinically relevant differences in bowel preparation, using the Boston Bowel Preparation Scale, resulting in 500 patients per group, 1000 patients in total.



DISCUSSION
The aim of this trial is to establish the position of online computer based counseling as tool for the education of patients prior to colonoscopy. By choosing a direct comparison with the standard of care, being nurse counseling, both endoscopic quality measures and patient related outcome measures can be evaluated.

Is computer assisted instruction non-inferior to traditional nurse counseling as modality in patient education prior to colonoscopy in bowel cleanliness during endoscopy?

Measurement after education, prior and after colonoscopy

Computer Based Instruction at home