Interactive, multimedia software for patient colonoscopy education in an open access setting: A randomized, controlled trial

Introduction: Open access endoscopy provides challenges in meeting the professional and legal responsibilities of patient education. To overcome these challenges for colonoscopy, an interactive, multimedia program (CAI) was developed. We assessed the effectiveness of the program in a randomized trial. Methods: 96 patients referred from primary care physicians for a first time colonoscopy were enrolled. Appropriateness of colonoscopy was decided according to ASGE criteria. 49 were randomized to view the CAI 3 to 7 days before the procedure. The script was rendered 100% audio with patients controlling information reviewed. Still and animated graphics along with still photos and video clips were included. 47 randomized to the standard approach received a 2 page brochure describing the procedure at the time of scheduling. All patients met with the colonoscopist just prior to the exam in the procedure room for a brief discussion and to obtain informed consent. A comprehension test stressing informed consent and a composite anxiety scale were completed after this meeting, before the exam. A satisfaction questionnaire was completed and procedure outcomes determined within 7 days, Bivariate analyses were used to compare scores on the anxiety, satisfaction, and comprehension scales and differences in outcomes (complications, ease of procedure, return to usual pursuits, and procedure medications.) Results: Patient groups did not vary on any background variables selected including age, gender, race, education, procedure indication, and computer experience. The results demonstrated that the addition of computerized colonoscopy education increased patient comprehension (80% vs. 65% correct, p<.001) and satisfaction with information received relative to the usual approach (p<.001) However, 60% of the CAI and 74% of the standard group failed to recognize that serious complications may be life-threatening. No differences in patient outcomes or anxiety were observed. Conclusion: Patients receiving CAI before the day of the exam were more satisfied with care received. Enhanced comprehension provided by CAI contributed to improved satisfaction and should minimize malpractice actions based on informed consent. Irrespective of educational method, patient comprehension of the impact of complications is problematic.