Often patients undergo procedures without real informed consent being achieved due to technical language, jargon and time pressure, with up to half of patients finding it difficult to understand what their doctor tells them [1, 2]. Now a group of Australian doctors has prepared patients for surgery using iPads, and found that patients' understanding was much better than after a face-to-face consultation.
It is vitally important that patients understand what medical procedures they face, both so that they can cope better with the procedure, and so that they can give fully informed consent to the treatment. However, many patients come out of critical face-to-face interviews with doctors not really understanding what to expect or what they might have agreed to.
"Patients often find it difficult to understand the medical language used by Doctors during face-to-face standard verbal communication, and they often feel intimidated by the interaction", said lead researcher, Matthew Winter (Royal North Shore Hospital, Sydney, Australia). "Often doctors work within busy practises and clinical environments with time limiting the quality of a consult and or verbal consent for a procedure. Patients often find it difficult to comprehend their planned procedure. We have found patient's knowledge is greatly improved through the use of portable video media and is their overall preferred method of information delivery compared with standard verbal communication"
The researchers designed a randomised controlled trial (RCT) to check the understanding of 88 patients facing surgery for acute renal colic (the abdominal pain often caused by kidney stones). 45 of the patients discussed the forthcoming surgery with their doctor as normal, whereas 43 patients were given a video presentation with cartoon animation narrated by a Doctor which could be viewed on tablets such as an iPad. The patients were then questioned on their understanding of the medical procedure and their satisfaction regarding the information delivery technique. After this they were switched, with those who had received face-to-face counselling receiving the video, and vice versa, followed by the same questionnaire. Patients were then asked to give their overall preference of information delivery.
They found that that use of the video increased understanding by 15.5%, in comparison to the direct consultation. In addition, 71 patients (80.7%) preferred the video as against 17 (19.3%) who preferred the face-to-face meeting.
Commenting, Dr Winter said "Informed consent for patients undergoing procedures is both an ethical and legal responsibility and crucially important for optimising treatment. Patients should be intimately involved in deciding upon their treatment, and understanding their treatment is often vital to a good recovery. Although medicine has advanced by leaps and bounds, there has been little change to the informed consent procedure and how a doctor explains the treatment to the patient. Through the use of portable video media, a doctor can present his/her own practise and procedural technique in an innovative, dynamic and engaging manner.
"We are not saying that using portable video media should replace consent. Our work shows that there are alternatives to interviews, which can help significantly, improve patient understanding and satisfaction. Most patients prefer being able to use the portable media devices to a face-to-face consultation which benefits both clinician and patient through improved quality of care. Portable video media is a useful addition to the informed consent process and I predict will form a crucial component of this process in years to come".
Commenting, Professor Fiona Burkhard, chairman of the EAU Guidelines panel for Urinary Incontinence said: "This innovative approach to patient information, using a cartoon animation narrated by a doctor, allows each individual patient as much time as needed to understand the proposed procedure. It should not replace a face to face discussion with the physician, but will allow patients to meet the physician already informed and prepared, thus benefiting both the physician and the patient".
Note: This paper will be presented in Munich by Dr Sunny Nalavenkata.
This research was funded by the Central Coast Urology Research & Education Fund. An edited version of the video is available to journalists from the press office.