Using a multimedia presentation to improve patient understanding and satisfaction with informed consent for minimally invasive vascular procedures

The use of e-consent in surgery and application to neurosurgery: a systematic review and meta-analysis

INTRODUCTION

The integration of novel electronic informed consent platforms in healthcare has undergone significant growth over the last decade. Adoption of uniform, accessible, and robust electronic online consenting applications is likely to enhance the informed consent process and improve the patient experience and has the potential to reduce medico-legal ramifications of inadequate consent. A systematic review and meta-analysis was conducted to evaluate the utility of novel electronic means of informed consent in surgical patients and discuss its application to neurosurgical cohorts.

METHODS

A review of randomised controlled trials, non-randomised studies of health interventions, and single group pre-post design studies in accordance with the PRISMA statement. Random effects modelling was used to estimate pooled proportions of study outcomes. Patient satisfaction with the informed consent process and patients' gain in knowledge were compared for electronic technologies versus non-electronic instruments. A sub-group analysis was conducted to compare the utility of electronic technologies in neurosurgical cohorts relative to other surgical patients in the context of patient satisfaction and knowledge gain.

RESULTS

Of 1042 screened abstracts, 63 studies were included: 44 randomised controlled trials (n = 4985), 4 non-randomised studies of health interventions (n = 387), and 15 single group pre-post design studies (n = 872). Meta-analysis showed that electronic technologies significantly enhanced patient satisfaction with the informed consent process (P < 0.00001) and patients' gain in knowledge (P < 0.00001) compared to standard non-electronic practices. Sub-group analysis demonstrated that neurosurgical patient knowledge was significantly enhanced with electronic technologies when compared to other surgical patients (P = 0.009), but there was no difference in patient satisfaction between neurosurgical cohorts and other surgical patients with respect to electronic technologies (P = 0.78).

CONCLUSIONS

Novel electronic technologies can enhance patient satisfaction and increase patients' gain in knowledge of their surgical procedures. Electronic patient education tools can significantly enhance patient knowledge for neurosurgical patients. If used appropriately, these modalities can shorten and/or improve the consent discussion, streamlining the surgical process and improving satisfaction for neurosurgical patients.

Patient understanding: How should it be defined and assessed in clinical practice?

In order for patients to make autonomous decisions in a healthcare setting, they must understand relevant information. There is, however, a lack of consensus on how understanding should be defined or assessed in this context, despite the fact that in practice doctors are regularly required to judge whether a patient has understood medical information. Current accounts of patient decision-making often focus on the information which needs to be disclosed to the patient to support their autonomous decision-making. Far less attention has been afforded to questions about how we might determine whether a patient has understood the information disclosed to them. Theoretical approaches to the concept of understanding in this context, and practically useful frameworks for assessing it, are lacking. In this paper, I use a number of hypothetical clinical situations to explore the conditions that are required for a patient to adequately understand information in medical decision-making. Drawing upon the wider philosophical literature, I propose a number of criteria which are necessary for understanding in a medical context: patients must (1) grasp a body of information which (2) reasonably reflects a responsible body of medical professionals' best estimate of the truth, (3) to a degree which meets a context-specific threshold. These criteria may be helpful in guiding assessments of patient understanding in clinical practice.

Alternative Means of Informed Consent in Cardiology: Strategies and Effectiveness in a Group of Italian Patients

Informed consent practices in healthcare represent a fundamental element of patient-centred care; however, the traditional use of a written, paper-based description of the medical procedure to obtain informed consent presents many limitations. This research aimed to evaluate the effects of an alternative modality of obtaining informed consent using a brief informative video for patients waiting to undergo a coronary angiography procedure in Italy. The study involved 40 participants-28 males and 12 females (mean age: 68.55, SD = 13.03)-divided equally into two groups: one group received the video-based informed consent and the other received a traditional paper-based form. Each group was asked to fill in two questionnaires; one was created by the researchers to measure the patient's level of understanding of the given information and the perception of usefulness of the informed consent, and the other was the Depression Anxiety Stress Scales-21 (DASS-21), which evaluates levels of anxiety, depression and stress. A comparison of the results of the two groups showed that video-based informed consent allowed participants to better understand the given information, to feel more confident concerning their subjective comprehension of it and to perceive the video-based informed consent as more useful than the traditional one. The video-based informed consent did not lead to higher levels of anxiety, depression or stress among the participants. It can be hypothesized that video-based formats may represent a more useful, understandable and safe alternative to traditional paper-based informed consent in healthcare.

Incorporating a Patient Education Video With Provider Consultation to Improve Patient Satisfaction and Reduce Consultation Time Among New Patients Seeking Cosmetic Injections

The field of aesthetics is expanding more rapidly than ever before, bringing with it an influx of new-to-aesthetics patients who lack industry knowledge. We investigated ways to bridge this gap in knowledge and provide patients with important procedural information and also increase their satisfaction and confidence. We implemented this project to improve the delivery of preprocedural patient education via the implementation of an educational video. We collected data over a 16-week period and analyzed the results of the pre- and post-video implementation. We found that implementing the educational video decreased the average time the provider spent consulting with new patients considering injectable neuromodulators or dermal fillers. We also found that using the video increased the patient's preprocedural confidence and postprocedural satisfaction. Based on the results of our quality improvement project, we concluded that implementing a patient education video before performing cosmetic injectable procedures improved patient confidence and satisfaction and decreased provider consultation times.

Digital technology in informed consent for surgery: systematic review

BACKGROUND

Informed consent is an ethical and legal requirement in healthcare and supports patient autonomy to make informed choices about their own care. This review explores the impact of digital technology for informed consent in surgery.

METHODS

A systematic search of EBSCOhost (MEDLINE/CINAHL), Embase, Cochrane Central Register of Controlled Trials and Web of Science was performed in November 2021. All RCTs comparing outcomes of both digital and non-digital (standard) consent in surgery were included. Each included study underwent an evaluation of methodological quality using the Cochrane risk of bias (2.0) tool. Outcomes assessed included comprehension, level of satisfaction and anxiety, and feasibility of digital interventions in practice.

RESULTS

A total of 40 studies, across 13 countries and 15 surgical specialties were included in this analysis. Digital consent interventions used active patient participation and passive patient participation in 15 and 25 studies respectively. Digital consent had a positive effect on early comprehension in 21 of 30 (70 per cent) studies and delayed comprehension in 9 of 20 (45 per cent) studies. Only 16 of 38 (42 per cent) studies assessed all four elements of informed consent: general information, risks, benefits, and alternatives. Most studies showed no difference in satisfaction or anxiety. A minority of studies reported on feasibility of digital technology in practice.

CONCLUSION

Digital technologies in informed consent for surgery were found to have a positive effect on early comprehension, without any negative effect on satisfaction or anxiety. It is recommended that future studies explore the feasibility of these applications for vulnerable patient groups and busy surgical practice.

Ethical Aspects of Personalized Research and Management of Systemic Inflammatory Response Syndrome (SIRS) in Children

Systemic inflammatory response syndrome (SIRS) is a life-threatening condition with nonspecific symptoms. Because of that, defining a targeted therapy against SIRS in children and adults remains a challenge. The identification of diagnostic patterns from individualized immuneprofiling can lead to development of a personalized therapy. The aim of this study was to identify and analyze ethical issues associated with personalized research and therapy for SIRS in pediatric populations. We conducted an ethical analysis based on a principled approach according to Beauchamp and Childress' four bioethical principles. Relevant information for the research objectives was extracted from a systematic literature review conducted in the scientific databases PubMed, Embase and Web of Science. We searched for pertinent themes dealing with at least one of the four bioethical principles: "autonomy", "non-maleficence", "beneficence" and "justice". 48 publications that met the research objectives were included in the thorough analysis, structured and discussed in a narrative synthesis. From the analysis of the results, it has emerged that traditional paradigms of patient's autonomy and physician paternalism need to be reexamined in pediatric research. Standard information procedures and models of informed consent should be reconsidered as they do not accommodate the complexities of pediatric omics research.

Outreach and Engagement Efforts in Research on Down Syndrome: An NIH INCLUDE Working Group Consensus Statement

The National Institutes of Health formulated the Outreach and Engagement Working Group in Fall of 2019 to support the objectives of the INCLUDE Project (INvestigation of Co-occurring conditions across the Lifespan to Understand Down syndromE). This Working Group consisted of a multi-disciplinary team of stakeholders in research on Down syndrome that met to discuss best practices for outreach and engagement to Down syndrome communities, with an emphasis on representation and diversity. This review and consensus paper describes the importance of increasing representation in DS research for future cohort building and summarizes the priority issues identified by the Working Group members. An overview of Working Group activities is then presented, followed by consensus recommendations and a discussion of future opportunities and challenges.

Is Evar Feasible in Challenging Aortic Neck Anatomies? A Technical Review and Ethical Discussion

Background: Endovascular aneurysm repair (EVAR) has become an accepted alternative to open repair (OR) for the treatment of abdominal aortic aneurysm (AAA) despite “hostile” anatomies that may reduce its effectiveness. Guidelines suggest refraining from EVAR in such circumstances, but in clinical practice, up to 44% of EVAR procedures are performed using stent grafts outside their instruction for use (IFU), with acceptable outcomes. Starting from this “inconsistency” between clinical practice and guidelines, the aim of this contribution is to report the technical results of the use of EVAR in challenging anatomies as well as the ethical aspects to identify the criteria by which the “best interest” of the patient can be set. Materials and Methods: A literature review on currently available evidence on standard EVAR using commercially available endografts in patients with hostile aortic neck anatomies was conducted. Medline using the PubMed interface and The Cochrane Library databases were searched from 1 January 2000 to 6 May 2021, considering the following outcomes: technical success; need for additional procedures; conversion to OR; reintervention; migration; the presence of type I endoleaks; AAA-related mortality rate. Results: A total of 52 publications were selected by the investigators for a detailed review. All studies were either prospective or retrospective observational studies reporting the immediate, 30-day, and/or follow-up outcomes of standard EVAR procedures in patients with challenging neck anatomies. No randomized trials were identified. Fourteen different endo-grafts systems were used in the selected studies. A total of 45 studies reported a technical success rate ranging from 93 to 100%, and 42 the need for additional procedures (mean value of 9.04%). Results at 30 days: the incidence rate of type Ia endoleak was reported by 37 studies with a mean value of 2.65%; 31 studies reported a null migration rate and 32 a null conversion rate to OR; in 31 of the 35 studies that reported AAA-related mortality, the incidence was null. Mid-term follow-up: the incidence rate of type Ia endoleak was reported by 48 studies with a mean value of 6.65%; 30 studies reported a null migration rate, 33 a null conversion rate to OR, and 28 of the 45 studies reported that the AAA-related mortality incidence was null. Conclusions: Based on the present analysis, EVAR appears to be a safe and effective procedure—and therefore recommendable—even in the presence of hostile anatomies, in patients deemed unfit for OR. However, in order to identify and pursue the patient’s best interest, particular attention must be paid to the management of the patient’s informed consent process, which—in addition to being an essential ethical-legal requirement to legitimize the medical act—ensures that clinical data can be integrated with the patient’s personal preferences and background, beyond the therapeutic potential of the proposed procedures and what is generically stated in the guidelines.

Effectiveness of educational videos on patient's preparation for diagnostic procedures: Systematic Review and Meta-Analysis

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Patients’ anxiety and unfamiliarity are barriers to undergoing diagnostic procedures.

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Studies found educational videos more effective than other forms of information.

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Educational videos minimise anxiety and improve patient satisfaction.

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Educational videos enable medical procedures best practices.

Although diagnostic procedures are crucial for secondary prevention and patient disease control, they often trigger fear and anxiety. These reactions highlight the need to adopt effective interventions to improve patients’ experience and satisfaction. Recently, educational videos have been employed in preparing diagnostic procedures; however, there is no integrated understanding of their effects. This systematic review and meta-analysis aimed to assess the effectiveness of educational videos on patients’ anxiety and satisfaction regarding preparation for diagnostic procedures. Three scientific databases (PubMed; Web of Science, Scopus), were used in this systematic review. Studies about educational videos as a form of preparation for patients undergoing diagnostic procedures published between 2000 and 2021 were included. A meta-analysis was also conducted. Sixteen studies met the inclusion criteria for systematic review, and seven were included in the meta-analysis. Nine studies of the total sample were about vascular procedures and seven studies about other medical image procedures. Of the fourteen studies that evaluated the use of educational videos on patients’ anxiety, nine proved to reduce it significantly. Of the thirteen studies that evaluated satisfaction, seven showed a significant increase in the experimental group. Studies included in the meta-analysis show that educational video patient groups had lower anxiety levels than the control groups after the procedure. Although future studies are required, the results suggest that educational videos effectively prepare patients for diagnostic procedures, improving care quality.

A Multimetric Readability Analysis of Online Patient Educational Materials for Submental Fat Reduction

Background

Patients often utilize the Internet to seek information related to their care. This study assesses the readability of online patient educational materials for submental fat reduction.

Methods

Patient educational materials from the 12 most popular websites related to submental fat reduction were downloaded and assessed for readability grade level using 10 unique scales.

Results

Analysis of the 12 most popular websites (and corresponding 47 articles) revealed that patient educational materials were written, on average, at an 11th grade reading level. The Flesch Reading Ease score was 48.9 (range 39.8–59.2), representing a “difficult” level of reading. Mean readability grade levels (range 9–13th grade for individual websites) were as follows: Coleman-Liau, 11.1; Flesch-Kincaid, 10.8; FORCAST, 10.8; Fry Graph, 10.1; Gunning Fog, 12.7; New Dale-Chall, 10.1; New Fog Count, 11.8; Simple Measure of Gobbledygook, 11.7; Raygor, 6.7. No website was at the 6th grade reading level for patient educational materials recommended by the American Medical Association and National Institutes of Health.

Conclusions

Online patient educational materials for submental fat reduction are written well above the recommended reading level. Recognition of disparities in health literacy is necessary to enable patients to make informed decisions and become active participants in their own care.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  www.springer.com/00266

Graphic narrative based informed consent for bronchoscopy improves satisfaction in patients after lung-transplantation: A randomized controlled trial

OBJECTIVE

This study investigated the effects of supplementing standard informed consent (IC) with a graphic narrative on patient satisfaction, periprocedural anxiety and experience.

METHODS

Patients due to undergo first conscious surveillance bronchoscopy following lung transplantation were randomized to receive IC with (intervention group) or without (control group) a graphic narrative illustrating the procedure. The primary endpoint was overall patient satisfaction with the IC. Key secondary endpoints were change in state anxiety level, as measured by State Trait Anxiety Inventory, and a questionnaire assessing satisfaction with IC and adverse experience during bronchoscopy (judged by patient and examiners).

RESULTS

Sixty patients were randomized, and 59 patients were included in the analysis (30 intervention-group; 29 control-group). Overall patient satisfaction was higher in the intervention group 9.5 (²⁵Q-⁷⁵Q: 8.6-9.8) vs. 8.6 (²⁵Q-⁷⁵Q: 8.1-9.2), p = 0.028). Change in state anxiety level (before vs after informed consent) was similar between the groups. There were no significant differences in adverse experience during bronchoscopy.

CONCLUSION

Addition of a graphic narrative illustrating bronchoscopy improved patient satisfaction with IC but did not influence anxiety before and adverse experience during the procedure.

PRACTICE IMPLICATIONS

Supplementing the IC process with a procedure-specific graphic narrative may be a simple tool to improve patient satisfaction.

A Randomized Controlled Trial Evaluating the Effect of an Educational Video on Patient Understanding of Midurethral Sling

OBJECTIVE

The primary objective was to evaluate the use of a novel video for enhancing patient knowledge of midurethral sling compared with standard handout.

METHODS

Participants scheduled for midurethral sling were randomized to 1 of 2 preoperative educational interventions, either video or standard handout. The primary outcome was change in knowledge measured via a 15-question questionnaire completed immediately before and after the intervention. Secondary outcomes were knowledge retention, urinary symptoms, decision satisfaction, and regret measured via validated questionnaires at 2 and 6 weeks postoperatively. Data are presented as median (interquartile range) and comparisons between intervention groups made using non-parametric statistics. A sample size of 16 per arm was calculated to detect a 20% effect size.

RESULTS

Thirty-eight participants, 19 per site, were randomized from August 2019 to October 2020 and 37 (97%) completed the primary outcome per protocol. Median age was 51 years (18 years), and there were no significant demographic differences between groups. Participants randomized to video demonstrated greater change in knowledge than those randomized to handout (+8.5 (3) vs +2.0 (4), P < 0.0001). Those randomized to video demonstrated improved 6 week postoperative urinary symptoms (Urogenital Distress Inventory-6, 0.0 [8.3] vs 14.6 [26.0]; P = 0.02; Incontinence Severity Index, 0.0 [2] vs 3.0 [4]; P = 0.005). There were no differences in satisfaction with decision (5.0 [0] video vs 5.0 [0.9] handout; P = 0.48) or decision regret (1.0 [0.5] video vs 1.0 [0.8] handout; P = 0.80) at 6 weeks postoperatively.

CONCLUSIONS

A preoperative educational video improved knowledge and urinary symptoms after midurethral sling compared with a standard handout.

Understanding Immunotherapy Terminology: An Analysis of Provider-Patient Conversations

BACKGROUND

Immunotherapy terminology is complex and can be difficult for patients to understand, threatening informed consent. The aims of this exploratory study are to determine whether patients understand immunotherapy terminology and if the provider defining the term improves patient understanding.

METHODS

Conversations between oncology providers and patients discussing immunotherapy were observed(n=39), and technical terms used were noted. With consent, patients were interviewed post-conversation to assess their understanding of these terms(n=39). Comparisons of the terms were conducted using chi-square tests, Fisher's exact tests, or ANOVA where appropriate.

RESULTS

'Immunotherapy' was the most difficult for participants to understand with 48.7% (19/39) correctly defining immunotherapy. 'Immunotherapy agents' was understood 53.8% (14/26) of the time. 'Immune system' was well understood (88.5%;23/26). Providers defined immunotherapy in 97.4% of conversations. There was no correlation between having immunotherapy defined in the conversation, and the likelihood of a correct definition (p=0.487). 'Immune system' was defined in 92.3% of conversations (n=26), and defining it in the conversation was correlated with increased patient understanding (p=0.009).

CONCLUSION

Our results indicate that patients have difficulty understanding some immunotherapy terminology. Since patient understanding of key terminology is crucial for informed consent and patient care, it is essential to implement interventions to improve understanding.

A Randomized Controlled Trial of a Multimedia Patient Education Tool for Stress Versus Urgency Urinary Incontinence

OBJECTIVE

The aim of this study was to determine whether there was a difference in patient education when comparing traditional conversation-based patient counseling with multimedia-based patient counseling about stress and urgency urinary incontinence.

METHODS

Patients seeking treatment for urinary incontinence were randomized to traditional, conversation-based counseling from a physician regarding stress and urgency urinary incontinence (control group) or view a video (multimedia) as their counseling (treatment group). A vignette-based assessment of the patient's knowledge of stress and urgency urinary incontinence was administered as a pretest, immediate posttest, and 6- to 8-week delayed posttest. The Incontinence Impact Questionnaire, short form, was used to assess quality of life and was administered at the initial visit and at the 6- to 8-week follow-up call. Patient satisfaction was recorded at the end of the initial visit using a continuous visual analog scale, and health literacy was evaluated using the Rapid Estimate of Adult Literacy in Medicine-Short Form or Short Assessment of Health Literacy-Spanish.

RESULTS

In the 98 participants, immediate posttest scores trended toward significance between the control and treatment groups (P = 0.086). This trend was lost at the delayed posttest (P = 0.122). Both methods of education showed a significant difference between pretest, immediate posttest, and delayed posttest (P < 0.001). There were no demographic differences between groups.

CONCLUSIONS

Multimedia-based patient education represents an effective method of providing patient education regarding urinary incontinence because those who received video education showed comparable comprehension of this topic when compared with standard physician counseling. Video education can feasibly be used as an alternative to, or in conjunction with, current patient education practices in a urogynecology setting.

The use of telemedicine to support interventional pain care: case series and commentary

Incorporating indicated interventions in a multimodal approach to manage musculoskeletal pain has become standard of care. For example, in patients with radicular pain associated with intervertebral disc herniation or lumbar spinal stenosis, epidural steroid injections (ESI) are commonly used and often improve pain and function while avoiding more invasive surgical approaches. Recently, the coronavirus disease 2019 (COVID-19) pandemic has allowed remote evaluations to mitigate COVID-19 transmission using telemedicine. In this article, we review our experience in using telemedicine for interventional pain care and current literature, providing a framework for current practice and future study. During restrictive periods of COVID-19 mitigation, patients were referred for ESI, evaluated by telemedicine, and then seen in-person for a physical exam and possible ESI. After a chart review of these patients, we found that telemedicine evaluation was successfully used to support decision making about the ESI. The majority of patients referred received an ESI. During the interval between telemedicine evaluation and ESI, there was no evidence of progression of disease or neurologic deterioration. There were no emergency room visits due to pain complaints. In our literature review, similar case series supported the use of telemedicine in planning and supporting procedural care in several clinical specialties, including interventional pain management. Future research in larger cohorts will help rigorously evaluate safety and query satisfaction for both patients and providers. In conclusion, we suggest that using telemedicine to support procedural care requires more research but shows promise in increasing access to interventional pain care. The use of telemedicine has recently seen a sharp increase in frequency due to the ongoing global COVID-19 pandemic. According to the World Health Organization, telemedicine represents "healing at a distance"1 . They define telemedicine as "the delivery of healthcare services…by health care professionals using information and communication technologies for the exchange of valid information for the diagnosis, treatment, and prevention of disease and injuries." Telemedicine has become an important and effective option for providing patient care. However, the use of telemedicine in the context of procedural therapies for pain management is new and rapidly evolving. In this commentary, we aimed to review literature and share our experience in integrating telemedicine in procedural care.

Evaluation of two communication tools, slideshow and theater, to improve participants' understanding of a clinical trial in the informed consent procedure on Pemba Island, Tanzania

BACKGROUND

Clinical trial participants are required to sign an informed consent form (ICF). However, information is lacking on the most effective methods to convey trial relevant information prior to inviting participants to sign the ICF, being particularly pertinent in low-income countries. A previous study on Pemba Island, Tanzania, found that a verbal information session (IS) was significantly better than providing an ICF alone. However, knowledge gaps remained. Building on these findings, we investigated the effect of adding a slideshow or a theater to the IS in the informed consent procedure of an anthelminthic clinical trial.

METHODOLOGY/PRINCIPAL FINDINGS

A total of 604 caregivers were randomized into the control group that only received an ICF (n = 150) or an ICF plus one of three intervention strategies: (i) verbal IS (n = 135), (ii) verbal IS with a slideshow (n = 174) or (iii) verbal IS followed by a theater (n = 145). All modes of information covered the same key messages. Participants' understanding was assessed using a semi-structured questionnaire. The mean score of caregivers in the control group (ICF only) was 4.41 (standard deviation = 1.47). Caregivers attending the IS alone were more knowledgeable than those in the control group (estimated difference in mean scores: 2.40, 95% confidence interval (CI) 1.95 to 2.86, p < 0.01). However, there was no evidence of an improvement compared to the IS only when participants attended a slideshow (0.09, 95% CI -0.53 to 0.35, p = 0.68) or a theater (0.28, 95% CI -0.27 to 0.82, p = 0.32). Three out of 10 key messages remained largely misunderstood, regardless of the mode of information group.

CONCLUSIONS/SIGNIFICANCE

Our study confirmed that, in this setting, an ICF alone was not sufficient to convey clinical trial-related information. An IS was beneficial, however, additional theater and slideshows did not further improve understanding. Future research should explore methods to improve communication between study teams and participants for different key messages, study types and settings.

A comparative assessment of information recall and comprehension between conventional leaflets and an animated video in adolescent patients undergoing fixed orthodontic treatment: A single-center, randomized controlled trial

INTRODUCTION

The objective of this 2-arm parallel trial was to investigate the recall and comprehension of the information of orthodontic patients undergoing fixed orthodontic treatment using either the verbal explanation supported with the British Orthodontic Society (BOS) leaflet or 3-dimensional (3D) animated content.

METHODS

Patients aged 12-18 years, with no relevant medical history or learning and reading difficulties, who were to undergo orthodontic treatment, were randomized to receive information about fixed orthodontic treatment, using either verbal explanation supported with the BOS leaflet or 3D animated content on the basis of the BOS leaflet. Randomization was performed by block randomization; block size of 4 was used, from which 6 blocks with 6 different sequences (AABB, ABBA, ABAB, BBAA, BAAB, BABA). The blinded author asked patients a series of open-ended questions. The primary outcome measure was the total score of the questions. An independent 2 sample t test was conducted to determine if there was a statistical difference in total questions score between the conventional method (verbal and leaflet) and the 3D animation at the time of consent taking (T0) and again 1 year later (T1). The secondary outcome measure was the time spent by the clinician delivering the information to the patient.

RESULTS

Thirty-two patients were randomized into each group. After 1 year, 1 patient was lost in each group. At the time of consent, the conventional group scored 79.1 ± 18.4 compared with 76.4 ± 12.8 for the 3D animation group with no statistically significant difference (95% confidence interval, -11.0 to 5.3), (P = 0.492). One year later, again, there was no statistically significant difference (P = 0.639) between the conventional group (75.6 ± 12.3) and the 3D animation group (74.4 ± 9.0) (95% confidence interval, -7.0 to 4.4). The average exposure time to the educational intervention in the conventional group was 8.5 minutes more than the 3D animation group.

CONCLUSIONS

The use of 3D animation or verbal and leaflet information is relatively equivalent in transferring knowledge to the orthodontic patient. The use of a 3D animated video reduces the clinician time needed in the clinic to deliver information to the patients and also allows multiple views and better suits the younger generation. Patients undergoing short- or long-term orthodontic treatment do not recall root damage as a risk of orthodontic treatment, which requires special attention from the orthodontist to reinforce this information.

REGISTRATION

This trial was not registered.

PROTOCOL

The protocol was not published before trial commencement.

Improving Surgical Informed Consent: Unanswered Questions

Objective

This study reviews randomized clinical trials that have attempted to improve the process of informed consent. Consent should be guided by the ethical imperatives of autonomy, beneficence, and social justice.

Summary Background

Informed consent is constantly evolving. Yet our review of the randomized trials done to improve the surgical informed consent process raises a number of questions: How does one define surgical informed consent? What interventions have been tried to measure and improve informed consent? Have the interventions in informed consent actually led to improvements? What efforts have been made to improve informed consent? And what steps can be taken to improve the process further?

Methods

A literature search for randomized controlled trials (RCTs)on informed consent identified 70 trials. Demographics, interventions, assessments, and a semi-quantitative summary of the findings were tabulated. The assessments done in the RCTs, show the surrogate for patient autonomy was comprehension; for beneficence, satisfaction and mental state (anxiety or depression); and, for social justice, language, literacy, learning needs, and cost.

Results

There were 4 basic categories of interventions: printed matter; non-interactive audiovisual tools; interactive multimedia; and a smaller group defying easy description. Improvement was documented in 46 of the 65 trials that studied comprehension. Thirteen of 33 trials showed improved satisfaction. Three of 30 studies showed an increase in anxiety. Few studies tried to assess primary language or literacy, and none looked at learning needs or cost.

Conclusions

No single study improved all 3 principles of informed consent. Validated interventions and assessments were associated with greater impact on outcomes. All 3 ethical principles should be assessed; autonomy (as comprehension), beneficence (as satisfaction, anxiety), and social justice. Not enough consideration has been given to social justice; appropriate language translation, standardized reading levels, assessment of learning needs, and cost to the individual are all important elements worthy of future study.

Decision aids to prepare patients for shared decision making: Two randomized controlled experiments on the impact of awareness of preference-sensitivity and personal motives

Objective

To participate in shared decision making (SDM), patients need to understand their options and develop trust in their own decision‐making abilities. Two experiments investigated the potential of decision aids (DAs) in preparing patients for SDM by raising awareness of preference‐sensitivity (Study 1) and showing possible personal motives for decision making (Study 2) in addition to providing information about the treatment options.

Methods

Participants (Study 1: N = 117; Study 2: N = 217) were put into two scenarios (Study 1: cruciate ligament rupture; Study 2: contraception), watched a consultation video and were randomized into one of three groups where they received additional information in the form of (a) narrative patient testimonials; (b) non‐narrative decision strategies; and (c) an unrelated text (control group).

Results

Participants who viewed the patient testimonials or decision strategies felt better prepared for a decision (Study 1: P < .001, ηP2 = 0.43; Study 2: P < .001, ηP2 = 0.57) and evaluated the decision‐making process more positively (Study 2: P < .001, ηP2 = 0.13) than participants in the control condition. Decision certainty (Study 1: P < .001, ηP2 = 0.05) and satisfaction (Study 1: P < .001, ηP2 = 0.11; Study 2: P = .003, d = 0.29) were higher across all conditions after watching the consultation video, and certainty and satisfaction were lower in the control condition (Study 2: P < .001, ηP2 = 0.05).

Discussion

Decision aids that explain preference‐sensitivity and personal motives can be beneficial for improving people's feelings of being prepared and their perception of the decision‐making process. To reach decision certainty and satisfaction, being well informed of one's options is particularly relevant. We discuss the implications of our findings for future research and the design of DAs.

Integrated Digital Patient Education at the Bedside for Patients with Chronic Conditions: Observational Study

BACKGROUND

Patient education delivered by a health care provider increases patients' understanding and adherence to medical instructions, which helps to improve patient health. Multiple challenges exist to delivering effective patient education to patients with multiple chronic conditions, including giving the necessary time, range, and types of learning materials, and assessing the level of understanding. To help overcome these challenges, it is important to study new electronic means to assist in patient education, such as the use of mobile devices, interactive media, 3-dimensional images, and multimedia educational content at the bedside.

OBJECTIVE

The goal of this study was to address the need for blended learning strategies combining technical and workflow integration of digital patient education systems for patients with chronic conditions within and across the regular process of care. Studies are needed to evaluate the utility and benefits of these technologies for providers and patients alike.

METHODS

A mixed-methods approach was employed including survey administration to 178 patients after they received digital patient education in person with a health care provider, and qualitative interviews with 16 nurse educators who used the mobile digital health education technology to deliver instruction to patients. Patient survey data were analyzed using chi-square statistical tests. Qualitative interviews were analyzed for user acceptance and perceived value themes.

RESULTS

Patients who were counseled using a blended digital health education approach reported improved understanding of educational content (P=.034) and chronic health conditions (P<.001), were more motivated to care for themselves at home (P<.001), were more likely to say that they felt capable of making health care decisions with their doctors (P<.001) and on their own (P=.001), and were more likely to report their intention to follow their doctor's instructions (P<.001) than were patients whose education was not computer-based. Nurse educators felt that the digital education system and content enhanced their education efforts and could be easily integrated into the outpatient clinical workflow.

CONCLUSIONS

Patient education for individuals with chronic conditions may be more effective than traditional formats when provided in blended digital formats supervised by a health care provider.

Potential Benefits of Multimedia-Based Home Catheter Management Education in Patients With Peripherally Inserted Central Catheters: Systematic Review

Background

In recent years, there have been many suggestions to use multimedia as a strategy to fully meet the educational needs of patients with peripherally inserted central catheters. However, the potential benefits remain unreliable in the literature.

Objective

In this study, we identified the potential benefits of multimedia-based home catheter management education in patients with peripherally inserted central catheters and discussed the clinical implications.

Methods

We performed systematic searches of the PubMed, Cochrane Library, Embase Ovid, Medline, BioMed Central-cancer (BMC-cancer), ScienceDirect, and Google Scholar databases without date constraints until November 30, 2019. The methodological quality of the eligible studies was appraised using the Cochrane risk of bias tool. Narrative synthesis of the study findings was conducted.

Results

A total of 6 intervention studies met the inclusion criteria, including 3 randomized controlled trials and 3 case-control studies/quasi-experimental studies. The studies included a total of 355 subjects, including a total of 175 in the multimedia groups and 180 in the control groups. We identified 4 potential benefits to patients: (1) improved knowledge, (2) increased satisfaction, (3) reduced incidence of catheter-related complications, and (4) reduced number of cases of delayed care after complications.

Conclusions

The current systematic review highlights the potential benefits of multimedia-based home catheter management education for patients with peripherally inserted central catheters.

Effect of video-assisted education on informed consent and patient education for peripherally inserted central catheters: a randomized controlled trial

OBJECTIVE

To evaluate the effects of a video-assisted education intervention on informed consent and patient education for peripherally inserted central catheters (PICCs).

METHODS

We conducted a randomized controlled trial comparing the effects on informed consent of video-assisted patient education and traditional face-to-face discussion in a catheter outpatient ward of a cancer centre in Guangzhou, China, in 2018. Participants were 140 patients randomly allocated (1:1 ratio) to two groups: video-assisted or traditional intervention. General information, patient retention of PICC-related information, working time spent by nurses on the procedure, and patient and nurse satisfaction with the procedure were assessed.

RESULTS

The time used for informed consent was significantly shorter in the experimental group (1.02 ± 0.24 minutes) than in the control group (6.87 ± 1.10 minutes). The time used for PICC-related education was significantly shorter in the experimental group (1.03 ± 0.28 minutes) than in the control group (5.11 ± 0.57 minutes). Nurses' degree of satisfaction with the procedure was significantly higher in the experimental group (4.10 ± 0.57) than in the control group (2.60 ± 0.70).

CONCLUSION

The use of video-assisted informed consent and patient education in this cancer centre decreased nurses' working time and improved nurses' satisfaction.Clinical trial registration number: ChiCTR1800015664.

A randomized controlled trial comparing video-assisted informed consent with standard consent for Mohs micrographic surgery

Background

There is a need for improvement in informed medical consent to address the lack of standardization and to increase patient engagement.

Objective

To investigate the use of a video to aid informed consent for Mohs micrographic surgery and evaluate patient understanding, satisfaction, anxiety, and time savings relative to verbal consent.

Methods

A 2-armed randomized controlled trial involving 102 patients compared video-assisted consent with a control group who underwent consent in the standard verbal manner. All participants underwent questionnaire-based testing of knowledge, satisfaction, and anxiety, and the time of each consultation was measured.

Results

Patients who watched the video performed significantly better in the knowledge questionnaire compared with the control group (P = .02), were more satisfied with their understanding of the risks of Mohs micrographic surgery (P = .013), and spent less time with their physician (P = .008). Additionally, 78.4% of video group patients reported that they preferred seeing the video before speaking with their physician.

Limitations

The study design may not replicate day-to-day clinical practice.

Conclusion

Video-assisted consent for Mohs micrographic surgery improves patient knowledge, leads to a better understanding of the risks, and saves physicians time without compromising patient satisfaction and anxiety levels in this study setting.

Donor information in research and drug evaluation with induced pluripotent stem cells (iPSCs)

Background

The discovery of induced pluripotent stem cells (iPSCs) opened the possibilities for reprogramming cells back to a pluripotent state. Because of no apparent ethical issues connected with donation and derivation of biomaterial, iPSCs are considered as a research alternative to ethically highly disputed human embryonic stem cells (hESCs). However, the unique character of iPSCs leads to numerous ethical considerations, which mainly concern the issue of donor information and consent for the use of biospecimen in research and drug evaluation.

Methods

For the purpose of this analysis, we conducted a review of the literature in the PubMed/MEDLINE and Web of Science databases. The search algorithm led to the identification of 1461 results. After removing duplicates and screening of title and abstract, 90 articles were found to be relevant to the study’s objective. Full texts of these articles were apprised and 62 articles were excluded at this step for not properly addressing the study’s objective. In the final step, 28 articles were included in the analysis. Analyzed were both research and non-research manuscripts published in peer-reviewed journals.

Results

In the case of iPSC research, the information process should be guided by general frameworks established for research on human subjects but also by specific characteristics of iPSCs. We determined four main domains and 12 thematic subdomains that should be included in donor information. Our results show that majority of authors agree to the content of information with regard to the areas of general information, storage of cells, and protection of privacy. Two main issues that are discussed in the literature are donor’s consent for use in future studies and the process of donor information.

Conclusions

Given the unique character of iPSCs and the possibility of their various uses in the future, the content of donor information should contain specific information central to iPSC research. Effective methods of communicating information to donors should combine written and oral information with the possible use of multimedia.

Interventions to Improve Patient Comprehension in Informed Consent for Medical and Surgical Procedures: An Updated Systematic Review

Background. Patient comprehension is fundamental to valid informed consent. Current practices often result in inadequate patient comprehension. Purpose. An updated review to evaluate the characteristics and outcomes of interventions to improve patient comprehension in clinical informed consent. Data Sources. Systematic searches of MEDLINE and EMBASE (2008-2018). Study Selection. We included randomized and nonrandomized controlled trials evaluating interventions to improve patient comprehension in clinical informed consent. Data Extraction. Reviewers independently abstracted data using a standardized form, comparing all results and resolving disagreements by consensus. Data Synthesis. Fifty-two studies of 60 interventions met inclusion criteria. Compared with standard informed consent, a statistically significant improvement in patient comprehension was seen with 43% (6/14) of written interventions, 56% (15/27) of audiovisual interventions, 67% (2/3) of multicomponent interventions, 85% (11/13) of interactive digital interventions, and 100% (3/3) of verbal discussion with test/feedback or teach-back interventions. Eighty-five percent of studies (44/52) evaluated patients' understanding of risks, 69% (41/52) general knowledge about the procedure, 35% (18/52) understanding of benefits, and 31% (16/52) understanding of alternatives. Participants' education level was reported heterogeneously, and only 8% (4/52) of studies examined effects according to health literacy. Most studies (79%, 41/52) did not specify participants' race/ethnicity. Limitations. Variation in interventions and outcome measures precluded conduct of a meta-analysis or calculation of mean effect size. Control group processes were variable and inconsistently characterized. Nearly half of studies (44%, 23/52) had a high risk of bias for the patient comprehension outcome. Conclusions. Interventions to improve patient comprehension in informed consent are heterogeneous. Interactive interventions, particularly with test/feedback or teach-back components, appear superior. Future research should emphasize all key elements of informed consent and explore effects among vulnerable populations.

Informed consent procedure in a double blind randomized anthelminthic trial on Pemba Island, Tanzania: do pamphlet and information session increase caregivers knowledge?

BACKGROUND

In clinical research, obtaining informed consent from participants is an ethical and legal requirement. Conveying the information concerning the study can be done using multiple methods yet this step commonly relies exclusively on the informed consent form alone. While this is legal, it does not ensure the participant's true comprehension. New effective methods of conveying consent information should be tested. In this study we compared the effect of different methods on the knowledge of caregivers of participants of a clinical trial on Pemba Island, Tanzania.

METHODS

A total of 254 caregivers were assigned to receive (i) a pamphlet (n = 63), (ii) an oral information session (n = 62) or (iii) a pamphlet and an oral information session (n = 64) about the clinical trial procedures, their rights, benefits and potential risks. Their post-intervention knowledge was assessed using a questionnaire. One group of caregivers had not received any information when they were interviewed (n = 65).

RESULTS

In contrast to the pamphlet, attending an information session significantly increased caregivers' knowledge for some of the questions. Most of these questions were either related to the parasite (hookworm) or to the trial design (study procedures).

CONCLUSIONS

In conclusion, within our trial on Pemba Island, a pamphlet was found to not be a good form of conveying clinical trial information while an oral information session improved knowledge. Not all caregivers attending an information session responded correctly to all questions; therefore, better forms of communicating information need to be found to achieve a truly informed consent.

[The Future of Vascular Medicine - Role of 3D Printing]

Digitalisation is one of the key challenges in current surgery and will impact the future of surgical care as well as upcoming generations of surgeons. 3D printing is a technology that has recently been transferred from industrial prototyping into cardiovascular medicine. The digital model of the anatomical structure which needs to be engineered represents the inherent link of 3D printing to digital medicine. 3D printing technology is able to provide the surgeon with patient-specific models of anatomy and disease for surgical planning and patient informed consent as well as training templates for students and residents, surgical templates and even ready-to-use surgical implants. In our service, we have established a full-inhouse workflow for 3D printing and we currently use this technology for the generation of patient-specific models, training templates and for patient education, as will be presented in this article. Future advances in software solutions, printing polymers and easy-to-handle printers will further propagate and expand the applicability of this technology in cardiovascular medicine.

Oxford Video Informed Consent Tool (OxVIC): a pilot study of informed video consent in spinal surgery and preoperative patient satisfaction

OBJECTIVES

The British Association of Spinal Surgeons recently called for updates in consenting practice. This study investigates the utility and acceptability of a personalised video consent tool to enhance patient satisfaction in the preoperative consent giving process.

DESIGN

A single-centre, prospective pilot study using questionnaires to assess acceptability of video consent and its impacts on preoperative patient satisfaction.

SETTING

A single National Health Service centre with individuals undergoing surgery at a regional spinal centre in the UK.

OUTCOME MEASURE

As part of preoperative planning, study participants completed a self-administered questionnaire (CSQ-8), which measured their satisfaction with the use of a video consent tool as an adjunct to traditional consenting methods.

PARTICIPANTS

20 participants with a mean age of 56 years (SD=16.26) undergoing spinal surgery.

RESULTS

Mean patient satisfaction (CSQ-8) score was 30.2/32. Median number of video views were 2-3 times. Eighty-five per cent of patients watched the video with family and friends. Eighty per cent of participants reported that the video consent tool helped to their address preoperative concerns. All participants stated they would use the video consent service again. All would recommend the service to others requiring surgery. Implementing the video consent tool did not endure any significant time or costs.

CONCLUSIONS

Introduction of a video consent tool was found to be a positive adjunct to traditional consenting methods. Patient-clinician consent dialogue can now be documented. A randomised controlled study to further evaluate the effects of video consent on patients' retention of information, preoperative and postoperative anxiety, patient reported outcome measures as well as length of stay may be beneficial.

Improving quality of the informed consent process: Developing an easy-to-read, multimodal, patient-centered format in a real-world setting

OBJECTIVE

To develop a patient-centered informed consent and assessment tool written at a 6th grade-level that is multimodal, affordable, transportable, and readily modifiable for protocol updates.

METHODS

This quality improvement initiative was performed in two phases on an actively-recruiting study at a pediatric diabetes clinic. In phase I, 38 volunteers underwent the standard-paper consent process, a comprehension assessment and provided feedback. Using feedback and the structure of the Plan-Do-Study-Act cycle a multimodal consent and assessment were developed. In phase II, volunteers were randomized to the standard (n = 25) or the multimodal consent (n = 25) and all completed the same comprehension assessment via touch-screen tablet. Primary outcomes were comparison of the individual and total comprehension assessment scores.

RESULTS

Total comprehension scores were higher in the multimodal versus the standard consent group (p <  0.001) and on the elements of benefits (p <  0.001), risks (p <  0.001), volunteerism (p <  0.012), results (p <  0.001), confidentiality (p <  0.004) and privacy (p < 0.001).

CONCLUSION

A multimodal consent and assessment presented sequentially on a touch-screen tablet were patient-centered enhancements to standard consent.

PRACTICE IMPLICATIONS

Multimodal standardization of delivery with improved readability may strengthen the informed consent process.

Effect of a Multimedia Patient Decision Aid to Supplement the Informed Consent Process of a Peripherally Inserted Central Venous Catheter Procedure: Pre-Post Quasi-Experimental Study

Background

Informed consent is a complex process to help patients engage in care processes and reach the best treatment decisions. There are many limitations to the conventional consent process that is based on oral discussion of information related to treatment procedures by the health care provider. A conclusive body of research supports the effectiveness of multimedia patient decision aids (PtDAs) in the consent process in terms of patient satisfaction, increased knowledge about the procedure, reduced anxiety level, and higher engagement in the decision making. Little information is available about the effectiveness of multimedia PtDAs in the consent process of invasive therapeutic procedures such as the peripherally inserted central venous catheter (PICC).

Objective

The objective of this study was to examine the effectiveness of a multimedia PtDA in supplementing the consent process of the PICC for patients in 10 acute and intensive care units in terms of knowledge recall, knowledge retention, satisfaction with the consent process, and satisfaction with the PICC multimedia PtDA.

Methods

This pre-post quasi-experimental study included 130 patients for whom a PICC was ordered. Patients in the control group (n=65) received the conventional consent process for the PICC, while those in the intervention group (n=65) received the multimedia PtDA to support the consent process of a PICC. All patients were surveyed for knowledge recall and retention about the procedure and satisfaction with the consent process. Patients in the intervention group were also surveyed for their satisfaction with the multimedia PtDA.

Results

Compared with the control group, patients in the intervention group scored around 2 points higher on knowledge recall (t₁₂₅=4.9, P<.001) and knowledge retention (t₁₂₆=4.8, P<.001). All patients in the intervention group were highly satisfied with the multimedia PtDA, with a mean score of >4.5 out of 5 on all items. Items with the highest mean scores were related to the effect of the multimedia PtDA on knowledge retention (mean 4.9 [SD 0.2]), patient readiness to learn (mean 4.8 [SD 0.5]), complete understanding of the procedure-related complications (mean 4.8 [SD 0.4]), and patient role in maintaining the safety of the PICC (mean 4.8 [SD 0.5]). Patients in the two groups were highly satisfied with the consent process. However, 15% (10/65) patients in the control group reported that the following information was omitted from the discussion: patient and provider roles in the safety of the PICC, other treatment options, and common side effects. Furthermore, 2 patients commented that they were not ready to engage in the discussion.

Conclusions

The multimedia PtDA is an effective standardized, structured, self-paced learning tool to supplement the consent process of the PICC and improve patient satisfaction with the process, knowledge recall, and knowledge retention.

The Impact of Visualization Format and Navigational Options on Laypeople's Perception and Preference of Surgery Information Videos: Randomized Controlled Trial and Online Survey

Background

Patients need to be educated about possible treatment choices in order to make informed medical decisions. As most patients are medical laypeople, they find it difficult to understand complex medical information sufficiently to feel confident about a decision. Multimedia interventions such as videos are increasingly used to supplement personal consultations with medical professionals. Former research has shown that such interventions may have a positive effect on understanding, decision making, and emotional reactions. However, it is thus far unclear how different features of videos influence these outcomes.

Objective

We aimed to examine the impact of visualization formats and basic navigational options in medical information videos about cruciate ligament surgery on recipients’ knowledge gain, emotions, attitude, and hypothetical decision-making ability.

Methods

In a between-group randomized experiment (Study 1), 151 participants watched 1 of 4 videos (schematic vs realistic visualization; available vs unavailable navigational options). In a separate online survey (Study 2), 110 participants indicated their preference for a video design. All participants were medical laypeople without personal experience with a cruciate ligament rupture and were presented with a fictional decision situation.

Results

In Study 1, participants who used navigational options (n=36) gained significantly more factual knowledge (P=.005) and procedural knowledge (P<.001) than participants who did not have or use navigational options (n=115). A realistic visualization induced more fear (P=.001) and disgust (P<.001) than a schematic video. Attitude toward the surgery (P=.02) and certainty regarding the decision for or against surgery (P<.001) were significantly more positive after watching the video than before watching the video. Participants who watched a schematic video rated the video significantly higher than that by participants who watched a realistic video (P<.001). There were no significant group differences with regard to hypothetical decision making and attitude toward the intervention. In addition, we did not identify any influence of the visualization format on knowledge acquisition. In Study 2, 58 of 110 participants (52.7%) indicated that they would prefer a schematic visualization, 26 (23.6%) preferred a realistic visualization, 17 (15.5%) wanted either visualization, and 9 (8.2%) did not want to watch a video at all. Of the participants who wanted to watch a video, 91 (90.1%) preferred to have navigational options, 3 (3.0%) preferred not to have navigational options, and 7 (6.9%) did not mind the options.

Conclusion

Our study indicates that the perception of medical information videos is influenced by their design. Schematic videos with navigational options are the most helpful among all videos to avoid negative emotions and support knowledge acquisition when informing patients about an intervention. The visualization format and navigational options are important features that should be considered when designing medical videos for patient education.

Trial Registration

Deutsches Register Klinischer Studien DRKS00016003; https://www.drks.de/drks_web/ navigate.do?navigationId= trial.HTML&TRIAL_ID=DRKS00016003 (Archived by WebCite at http://www.webcitation.org/746ASSAhN)

[Design and assessment of a outpatient living with PICC-line support program: A pilot study]

The peripheral insertion central catheter (PICC-Line) is indicated for long term intravenous medication administration. Some adverse events (AE) might occur, especially for patients after hospital discharge. Therefore, patient empowerment about the side effects and precaution for use is essential to prevent potential patient harm. A multidisciplinary working group met and designed support program for outpatient living with PICC-line. Pharmacy consultations (PC) were proposed to patient before and after PICC-line insertion. A strip cartoon and card game were created to facilitate patient education. The aim of the study was to assess the comprehension of patient then secondarily to follow up AE awareness. During 10 months, 30 patients of mean age 65.9±14 years were included. Thirty-sixPICC-Line were installed and followed on 1659days of catheterization. 4, 9 and 13patients received respectively no, at least one and two PCs before discharge from the hospital. Although the differences were not statistically significant, comprehension tends to improve when patients benefit from both PCs especially when it concerns complications. Twenty-fiveambulatory AEs were recorded including 9infections or suspicion of infection, 2 thrombosis and 2 displacements of PICC-line. Among the patients who had no PC, four experienced delayed care. In comparison, it occurred in only one patient in the group who received at least one PC after PICC-line insertion. Further studies are warranted to confirm this trend.

Informed Consent for Patients Undergoing Transsphenoidal Excision of Pituitary Adenoma: Development and Evaluation of a Procedure-Specific Online Educational Resource

OBJECTIVE

The results of recent high-profile delict and medical negligence cases now require doctors to take "reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments." Thus, we report the development and evaluation of a procedure-specific online educational resource to support the informed consent process for patients undergoing transsphenoidal excision of pituitary adenomas.

METHODS

An interactive educational multimedia website was developed using a combination of text, images, and videos. A telephone questionnaire was devised to evaluate patients' understanding that included 15 true/false questions. The questionnaire was administered to separate cohorts of patients on the waiting list for transsphenoidal excision of a pituitary adenoma before and after introduction of the website. The patients were also asked to rate the extent to which they found the website easy to understand and useful on a 10-point Likert scale. Data were compared using the χ² and Mann-Whitney U test, with P < 0.05 considered to indicate statistical significance.

RESULTS

Ten consecutive patients completed the questionnaire before the introduction of the website and nine afterward. The median questionnaire scores were significantly greater after the introduction of the website (14 of 15 vs. 12 of 15; P = 0.002), and all patients subjectively found the website easy to understand and useful (10 of 10 in both groups).

CONCLUSIONS

An interactive educational multimedia website appears to be a helpful adjunct to the informed consent process for patients undergoing transsphenoidal excision of a pituitary adenoma.