E-PATIENT COUNSELING TRIAL (E-PACO): COMPUTER BASED PATIENT EDUCATION IS NON-INFERIOR TO NURSE COUNSELING PRIOR TO COLONOSCOPY, A MULTICENTER RANDOMIZED CONTROLLED TRIAL

Aim: Optimal patient education prior to colonoscopy improves adherence to instructions for bowel preparation and leads to cleaner colons. Endoscopy units are obligated to obtain informed consent prior to procedures, combined with risk assessment for use of sedative drugs. Current practice in the Netherlands to achieve both goals is a nurse counseling visit. This visit is costly and has disadvantages in terms of content uniformity and time consumption for both patient and the hospital. We developed a computer based education (CBE)supported by video and 3D animations. We hypothesized that CBE may replace nurse counseling in most cases, without losing quality of bowel cleanliness during colonoscopy. Design: A prospective, multicenter, endoscopist blinded, non-inferiority randomized controlled trial was conducted. The primary outcome was the rate of successful bowel cleansing, evaluated using the Boston Bowel Preparation Scale (BBPS). Secondary outcome measures were sickness absence due to outpatients clinic visit, patient anxiety and satisfaction scores and information re-call. Data was gathered through questionnaires, for endoscopist and patient, and endoscopy reports. The study was performed in four endoscopy units of different levels (rural, urban, tertiary). Inclusion criteria were adult age and referral for complete colonoscopy. Exclusion criteria were Dutch illiteracy, audiovisual handicaps or mental disabilities. Results: Out of 1035 eligible patients, we randomized 845 patients. After evaluation, 497 patients were included in our per-protocol analyses, 217 in the nurse counseling group and 280 in the CBE group. Baseline characteristics were similarly distributed among groups. Overall response rates for the three patient questionnaires were 100%, 55.6% and 47.3%. The endoscopist questionnaire was completed in 42%, however BBPS scores were retrieved in 95%. Successful bowel cleansing was achieved in 93.2 % (261/280)of the CBE group, which was non-inferior to the nurse counseling group (94%, 204/217), with a difference of -0.8% by per-protocol analysis [95% confidence interval (CI)-5.1 – 3.5]. BBPS scores were 7.8 (SD 1.62)and 8.0 (SD 1.69), respectively. Sickness absence was significantly more frequent in the nurse counseling group (28.0% vs 4.83%). In the CBE group, 21.8% of patients needed additional information, resulting in 4.8% extra outpatient clinic visits. Anxiety scores were comparable in both groups. Patient satisfaction scores were high, but not significantly higher using CBE. There was no significant difference in information recall. Conclusion: As modality for patient education, CBE is non-inferior to nurse counseling in terms of bowel cleanliness during colonoscopy, with lower patient sickness leave. CBE therefore is practical and efficient for patient education prior to colonoscopy and is recommended for daily practice. [Figure presented][Figure presented]