Veldhuijzen Govert, Klemt-Kropp Michael, Noomen Casper, Van Esch Aura A, Tjwa Eric T, Drenth Joost
Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Department of Gastroenterology and Hepatology, Medical Centre Alkmaar, Alkmaar, The Netherlands.
Endosc Int Open. 2017 Aug;5(8):E792-E797. doi: 10.1055/s-0043-110813. Epub 2017 Aug 7.
Better patient education prior to colonoscopy improves adherence to instructions for bowel preparation and leads to cleaner colons. We reasoned that computer assisted instruction (CAI) using video and 3 D animations followed by nurse contact maximizes the effectiveness of nurse counselling, increases proportion of clean colons and improves patient experience.
Adults referred for colonoscopy in a high-volume endoscopy unit in the Netherlands were included. Exclusion criteria were illiteracy in Dutch and audiovisual handicaps. Patients were prospectively divided into 2 groups, 1 group received nurse counselling and 1 group received CAI and a nurse contact before colonoscopy. The main outcome, cleanliness of the colon during examination, was measured with Ottawa Bowel Preparation Scale (OBPS) and Boston Bowel Preparation Scale (BBPS). We assessed patient comfort and anxiety at 3 different time points.
We included 385 patients: 197 received traditional nurse counselling and 188 received CAI. Overall patient response rates were 99 %, 76.4 % and 69.9 % respectively. Endoscopists scored cleanliness in 60.8 %. Comparative analysis of the 39.2 % of patients with missing scores showed no significant difference on age, gender or educational level. Baseline characteristics were evenly distributed over the groups. Bowel cleanliness was satisfactory and did not differ amongst groups: nurse vs. CAI group scores in BBPS: (6.54 ± 1.69 vs. 6.42 ± 1.62); OBPS: (6.07 ± 2.53 vs. 5.80 ± 2.90). Patient comfort scores were significantly higher (4.29 ± 0.62 vs. 4.42 ± 0.68) in the CAI group shortly before colonoscopy. Anxiety and knowledge scores were similar.
CAI is a safe and practical tool to instruct patients before colonoscopy. We recommend the combination of CAI with a short nurse contact for daily practice.
结肠镜检查前更好地对患者进行教育可提高患者对肠道准备说明的依从性，并使结肠更清洁。我们推断，使用视频和3D动画的计算机辅助教学（CAI），随后由护士进行跟进，可使护士咨询的效果最大化，提高清洁结肠的比例，并改善患者体验。
纳入荷兰一家大容量内镜检查单位中被转诊进行结肠镜检查的成年人。排除标准为荷兰语文盲和视听障碍。患者被前瞻性地分为两组，一组接受护士咨询，另一组在结肠镜检查前接受CAI及护士跟进。主要结局指标，即检查时结肠的清洁度，采用渥太华肠道准备量表（OBPS）和波士顿肠道准备量表（BBPS）进行测量。我们在3个不同时间点评估了患者的舒适度和焦虑程度。
我们纳入了385例患者：197例接受传统护士咨询，188例接受CAI。总体患者回复率分别为99%、76.4%和69.9%。内镜医师对60.8%的患者的清洁度进行了评分。对39.2%评分缺失患者的比较分析显示，在年龄、性别或教育水平方面无显著差异。基线特征在各组中分布均匀。肠道清洁度令人满意，且各组之间无差异：护士咨询组与CAI组的BBPS评分分别为（6.54±1.69对6.42±1.62）；OBPS评分分别为（6.07±2.53对5.80±2.90）。在结肠镜检查前不久，CAI组的患者舒适度评分显著更高（4.29±0.62对4.42±0.68）。焦虑和知识评分相似。
CAI是结肠镜检查前指导患者的一种安全实用的工具。我们建议在日常实践中将CAI与简短的护士跟进相结合。
