E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy

This protocol addresses the issue of patient education in the current online era. Although modern life implements web-based solutions at high pace, patient education is lagging behind. Computer-based education, which empowers patients in time, place, and pace of learning, has shown a positive impact on patient satisfaction, with several operational benefits.

Demonstrating the procedure will be Kirill Pavlov, a gastroenterology resident from my department. He will perform the role of a patient undergoing computer-based education, illustrating every step of the process. All referred patients for colonoscopy are asked to participate in the trial and reasons for refusal are recorded.

Inclusion criteria are adult age and referral for a complete colonoscopy. Exclusion criteria are Dutch illiteracy, audiovisual handicaps, or mental disabilities and no peers with internet access. Patients are randomized to the intervention, computer-based education, or control, nurse counseling group per center after obtaining permission.

After the patient is educated, baseline questionnaires are filled out. At the day of their colonoscopy, patient and endoscopist fill out questionnaires at several time points before, during, and after colonoscopy. We will now show in detail the intervention in our trial.

Have the patient read the pop-up with instructions on how to use the CBE and click on the Explanation of colonoscopy procedure"tab. Have the patient read How do you prepare for the examination? and click next.

Have the patient play the Just before the examination"video and proceed. Welcome to the Radboudumc, where the examination of your large intestine will take place. Next, play the Preparation for the examination"video for the patient, and continue.

Play the second Preparation for the examination"video and click next. Play The endoscope"video and click on the right of the screen. Play the Meeting with the doctor"video and proceed.

Play the Time Out Procedure"video and click next. Play the Sedative"video and advance. After the last video, have the patient read the Location of the intestines"text and continue.

An automated 3-D animation of the small intestine will appear. Have the patient drag to rotate the 3-D image while reading the Small intestine"text. When the patient has finished the text, have the patient click next and drag to rotate the 3-D image of the large intestine.

After reading the Large intestine"text, the patient should click next and drag to rotate the next 3-D image. Have the patient read the Continuation of large intestine examination"text and click on the right of the screen. A new automated 3-D animation will appear, centering on the anus.

Have the patient read the Alternative examination"text and advance. When the 3-D animation showing the entrance to the colon appears, have the patient play the Air infusion"video. At the end of the video, the patient should click next.

The Examination technique"will appear. After reading, have the patient click next. When the polyp animation appears, play the Removing the polyp"video and proceed.

At the end of the video, have the patient review the After the examination"video and click next. Now play the Examination report and follow-up appointment"video for the patient and continue. Have the patient read the Have a nice journey"text to the patient, and click next.

Have the patient read the Risks of the examination"and click on the right of the screen. Then have the patient fill out the medical history and medication use questionnaires on the Questionnaire and Informed Consent"slide, and click send when the forms have been completed. The form will prompt the endoscopy department to take automated action, like discontinuation of anticoagulant medication if indicated.

The two crucial steps in the protocol are first, the patient filling out the questionnaire, and second, returning it to the endoscopy department. A Preparation for the colonoscopy"tab will appear. Have the patient follow the steps and read all of the information on the use of the laxatives in the same step-wise fashion as just demonstrated.

When the patient has completed the colonoscopy preparation module, click on the Route to the department"tab to route the data to the endoscopy unit. In a pilot study comparing nurse instruction to computer assisted instruction as demonstrated, a significant improvement in patient comfort before endoscopy was observed in the computer assisted instruction group. As this rating was higher directly after nurse counseling it is important to consider the effects of the influence of a human factor per personal contact and for offering emotional support.

No significant differences between patient anxiety and information recall scores were determined. Nor were differences between the bowel preparation scores of the two groups observed, even using two different scales. After the patient returns the questionnaire, the endoscopy department must accurately assess the information provided.

If needed, extra information can be sent to the patient. This study protocol, using computer-based education, can be applied to other medical examinations. For instance, preparing a patient for surgery.