Patients who receive an audiotape of their consultation before undergoing heart surgery appear to have more knowledge about their procedures and their health, and also have reduced anxiety and depression, according to a report in the April issue of Archives of Surgery.
"Patients facing heart surgery are understandably anxious in the outpatient clinic and, as a consequence, are unlikely to absorb all the information presented to them," the authors write as background information in the article. "They also find it difficult to remember the various percentage figures quoted for risk of complication, success rate of alternative therapeutic options and other pertinent facts." This can impair the informed consent process, since valid consent must be obtained from a patient who is informed about the proposed treatment, any alternatives and the nature of the underlying condition.
Pankaj Kumar Mishra, M.R.C.S., of the Glasgow Royal Infirmary, Scotland, and colleagues studied 84 patients who had first-time coronary artery surgery conducted by one surgeon between February 2005 and March 2006. All of the patients' pre-surgery consultations were audiotaped; 30 participants were randomly assigned to receive this tape and told they could listen to it whenever they desired, 25 received a general 11-minute tape about coronary artery surgery and 29 received no tape. The patients were then interviewed upon being admitted to the hospital for surgery.
All patients who received the audiotaped consultations confirmed that they had listened to them; the duration ranged from 13 minutes to 32 minutes (average 24 minutes). The average knowledge score of patients in the consultation tape group was much higher than that of individuals who received no tape. In addition, they reported a greater sense of control with regard to their own health and also scored lower on measures of anxiety and depression.
"Concerns have been raised that detailed information can cause undue anxiety and distress to patients," the authors write. "However, it has also been shown that a well-informed patient copes more effectively with surgery, and this factor can result in earlier discharge and decreased incidence of psychological problems."
"Consultation audiotaped recordings offer patients a chance to listen to information that might have been missed during the consultation and refresh their memory; the recordings facilitate understanding of illness and treatment," they continue. "They also encourage patients to seek clarification of previously imparted information in subsequent encounters with health care professionals. The addition of an audiotaped recording of an outpatient consultation to written communication significantly increases patients' recall of information and satisfaction level, particularly in elderly patients."
Additional research is needed to ensure there are no adverse effects of providing these tapes in any subgroup of patients, and also to understand how best to integrate them into clinical practice, the authors conclude.
- Mishra et al. A Randomized Controlled Trial to Assess the Effect of Audiotaped Consultations on the Quality of Informed Consent in Cardiac Surgery. Archives of Surgery, 2010; 145 (4): 383 DOI: 10.1001/archsurg.2010.45
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