Patients facing planned surgery answered 36 per cent more questions about the procedure correctly if they watched an interactive multimedia presentation (IMP) rather than just talking to medical staff, according to research in the October issue of the urology journal BJUI.
Researchers from the University of Melbourne, Australia, randomised 40 patients due to undergo radical prostatectomy into two groups. The first group went through the standard surgery consent process, where staff explained the procedure verbally, and the second group watched the IMP.
Both sets of patients were then asked to answer 26 questions on the surgery they were due to undergo. 78 per cent of the IMP group achieved high test scores, compared with 57 per cent of the control group.
When they switched the two groups over, the control group's score went up by 11 per cent after the IMP, with the group who had originally seen the presentation showing no change.
"Our standard consent process comprised of patients receiving detailed information about the procedure from physicians and nurses, while the IMP provided consistent and animated information on the same topic" explains co-author Dr Nathan Lawrentschuk from the University's Department of Urology.
"The 51-slide IMP covered basic anatomy, how the prostate works and how the operation is carried out. It also outlined possible complications and provided postoperative information. 22 of the slides contained interactive questions that had to be answered correctly before the patient could move on to the next slide."
Patients completed the consent procedure about three-and-a-half weeks before their planned surgery. They had an average age of 61 and 70 per cent of the patients in both groups spoke English as their first language. Both groups had a similar education profile and the IMP only required minimal computer skills to complete.
The standard consent procedure lasted an average of 20 minutes and the IMP took an average of 18 minutes to complete. Most of the patients found the IMP easy to use and were satisfied with the information provided.
"Radical prostatectomy is a major procedure to remove the prostate gland and the cancer it contains" stresses Dr Lawrentschuk. "It is vital that patients facing major surgery are fully informed of the risks and benefits so that they can provide informed consent. But before they can do this, they must have a functional understanding of the information provided.
"We believe that using the IMP provides a better level of patient understanding than standard consent, by ensuring that the procedure and risks have been explained consistently and by actively testing the patient on the information they have received.
"It helps us to obtain ethical and legally informed consent, increase patient knowledge and reduce patient anxiety and potential dissatisfaction or legal consequences if the surgery is not as successful as anticipated.
"However, it is important to stress that patients using the IMP also had plenty of opportunities to raise any concerns they had about their procedure, and their general health, with medical staff during their pre-surgical assessment."
The authors point out that, although this particular IMP was developed for prostate cancer surgery, it has much wider potential and could be used by patients facing other kinds of surgery. Presentations could also be produced in a range of languages, with recorded voices replacing much of the text.
"Ultimately IMP might also be used for educating medical staff such as nurses, medical students and trainee surgeons" adds Dr Lawrentschuk.
- Dennis Gyomber, Nathan Lawrentschuk, Peter Wong, Frank Parker, Damien M. Bolton. Improving informed consent for patients undergoing radical prostatectomy using multimedia techniques: a prospective randomized crossover study. BJU International, 2010; 106 (8): 1152 DOI: 10.1111/j.1464-410X.2010.09309.x
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