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Cohen SM, Baimas-George M, Ponce C, Chen N, Bain PA, Ganske IM, Katz J, Luks FI, Kent TS. Is a Picture Worth a Thousand Words? A Scoping Review of the Impact of Visual Aids on Patients Undergoing Surgery. JOURNAL OF SURGICAL EDUCATION 2024; 81:1276-1292. [PMID: 38955659 DOI: 10.1016/j.jsurg.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/24/2024] [Accepted: 06/02/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE While graphics are commonly used by clinicians to communicate information to patients, the impact of using visual media on surgical patients is not understood. This review seeks to understand the current landscape of research analyzing impact of using visual aids to communicate with patients undergoing surgery, as well as gaps in the present literature. DESIGN A comprehensive literature search was performed across 4 databases. Search terms included: visual aids, diagrams, graphics, surgery, patient education, informed consent, and decision making. Inclusion criteria were (i) full-text, peer-reviewed articles in English; (ii) evaluation of a nonelectronic visual aid(s); and (iii) surgical patient population. RESULTS There were 1402 articles identified; 21 met study criteria. Fifteen were randomized control trials and 6 were prospective cohort studies. Visual media assessed comprised of diagrams as informed consent adjuncts (n = 6), graphics for shared decision-making conversations (n = 3), other preoperative educational graphics (n = 8), and postoperative educational materials (n = 4). There was statistically significant improvement in patient comprehension, with an increase in objective knowledge recall (7.8%-29.6%) using illustrated educational materials (n = 10 of 15). Other studies noted increased satisfaction (n = 4 of 6), improvement in shared decision-making (n = 2 of 4), and reduction in patient anxiety (n = 3 of 6). For behavioral outcomes, visual aids improved postoperative medication compliance (n = 2) and lowered postoperative analgesia requirements (n = 2). CONCLUSIONS The use of visual aids to enhance the surgical patient experience is promising in improving knowledge retention, satisfaction, and reducing anxiety. Future studies ought to consider visual aid format, and readability, as well as patient language, race, and healthcare literacy.
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Affiliation(s)
- Stephanie M Cohen
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Center for Visual Arts in Healthcare, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Maria Baimas-George
- Department of Transplant Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Cristina Ponce
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nova Chen
- Department of Neuroscience, Brown University, Providence, Rhode Island
| | - Paul A Bain
- Department of Research and Instruction, Harvard Medical School, Boston, Massachusetts
| | - Ingrid M Ganske
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts; Center for Visual Arts in Healthcare, Brigham and Women's Hospital, Boston, Massachusetts
| | - Joel Katz
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Center for Visual Arts in Healthcare, Brigham and Women's Hospital, Boston, Massachusetts
| | - Francois I Luks
- Department of Surgery, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Tara S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Lambrakos LK, Feigofsky SA, Wang Y, Ahmed FZ, Pachón M, Takata TS, Frazier-Mills CG, Kotschet E, Gravelin LM, Hsu JC. Enhancing patient acceptance of ICD implantation through structured shared decision making: conversation is key. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01850-7. [PMID: 39001909 DOI: 10.1007/s10840-024-01850-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/12/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-D) are lifesaving treatments for patients at risk for sudden cardiac death. Effective physician-patient communication during the shared decision-making process is essential. Electrophysiologist-patient conversations were targeted to obtain objective data on the interaction, understand the conversation framework, and uncover opportunities for improved communication. METHODS Individuals previously identified as requiring an ICD/CRT-D but declined implantation were recruited for this four-stage interview and survey-based study. Quantitative analysis of surveys and AI analysis of conversation videos was conducted to evaluate patient participant expectations, analyze feedback about the conversations with study physicians, and gauge willingness for device implantation. RESULTS The study included 27 patients (mean age 51 years, 51.9% female) and 9 study physicians. Patients were significantly more willing to undergo ICD/CRT-D implantation after conversing with study physicians compared to their own physicians and pre-conversation surveys (mean scores: 5.0, 3.1, and 4.4 out of 7, respectively; p < 0.001). Patient participants had higher satisfaction with the study conversation, rating study physicians higher in effectiveness of explanations, responsiveness to questions, and overall quality of the conversation compared to their own physicians (all p < 0.001). CONCLUSIONS In a cohort of patients who previously declined ICD/CRT-D implantation, patient satisfaction and willingness to undergo implantation of a guideline-directed device therapy increased significantly following a structured conversation with study physicians. Identified key elements could be integrated into user-friendly tools and educational materials to facilitate these conversations, improving patient engagement with the decision-making process and enhancing informed acceptance of indicated device therapies.
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Affiliation(s)
- Litsa K Lambrakos
- Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, 1321 NW 14th Street, Suite 510, Miami, FL, 33136, USA.
| | | | | | - Fozia Z Ahmed
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Marta Pachón
- Cardiology Department, Hospital Virgen de La Salud, Toledo, Spain
| | | | - Camille G Frazier-Mills
- Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA
| | - Emily Kotschet
- Monash Cardiac Rhythm Management Department, Monash Medical Centre, MonashHeartMelbourne, VIC, Australia
| | | | - Jonathan C Hsu
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, CA, USA
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Kusaibati AM, Sultan K, Hajeer MY, Burhan AS, Alam MK. Adult patient expectations and satisfaction: Can they be influenced by viewing the three-dimensional predicted outcome before fixed orthodontic treatment of dental crowding? J World Fed Orthod 2023; 12:269-279. [PMID: 37777351 DOI: 10.1016/j.ejwf.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/06/2023] [Accepted: 08/31/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Investigating the possible changes in patients' expectations of and satisfaction with the orthodontic treatment outcomes when they were given the three-dimensional digital prediction of their teeth alignment before the beginning of treatment. METHODS A prospective non-controlled single-group clinical trial was conducted on 28 (18 females, 10 males, mean age: 20.68 ± 1.91 years) patients with Class I malocclusion and moderate dental crowding who required a nonextraction orthodontic treatment. Patients were given the expectations questionnaire on their first visit (T0). Then, patients were shown a three-dimensional digital setup-created by Orthoanalyzer software (3Shape, Copenhagen, Denmark)-of the proposed treatment results before orthodontic treatment (T1) and received two questionnaires, the second expectations questionnaire and the satisfaction with the proposed changes questionnaire. Treatment was then initiated using the fixed appliances and completed. After debonding, a question about patients' satisfaction with the achieved changes was completed (T2). RESULTS Patients' expectations level significantly increased after watching the predicted alignment of teeth compared with the initial levels in terms of chewing (x¯ = 5.54 and x¯= 6.71), speech (x‾ =5.93 and x¯= 6.93), and oral hygiene improvement (x‾= 7.93 and x¯=8.61 ± 1.06; at T0 and T1, respectively). The remaining items showed no significant differences between the two assessment times. Patients had a higher level of satisfaction at the end of treatment than after watching the proposed outcome. There were significant statistical differences in the items related to teeth appearance (x¯= 9.12 and x¯= 9.60 at T1 and T2, respectively), and teeth engagement (x¯= 8.92 and x¯= 9.40 at T1 and T2, respectively) CONCLUSIONS: Watching the predicted alignment outcome increased patients' expectations of chewing, speech, and oral hygiene improvement compared with the initially recorded levels. Patients were more satisfied with the final result than what was recorded after viewing the predicted plan. However, these results were not clinically significant.
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Affiliation(s)
| | - Kinda Sultan
- Department of Orthodontics, Faculty of Dentistry, University of Damascus, Damascus, Syria
| | - Mohammad Y Hajeer
- Department of Orthodontics, Faculty of Dentistry, University of Damascus, Damascus, Syria.
| | - Ahmad S Burhan
- Department of Orthodontics, Faculty of Dentistry, University of Damascus, Damascus, Syria
| | - Mohammad Khursheed Alam
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
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Shreyas K, Jadhav A, Goel AD, Pathak M, Rathod K, Nayak S, Saxena R, Sinha A. Effect of Multimedia Teaching Tools in Parental Anxiety and Comprehension of Informed Consent Procedure in Pediatric Surgical Procedures: A Single Centre Randomized Control Trial. J Pediatr Surg 2023; 58:2000-2005. [PMID: 37217363 DOI: 10.1016/j.jpedsurg.2023.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/30/2023] [Accepted: 04/07/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Informed consent is an essential component of medical ethics. In children, the parent or legally authorized guardian must consent to any medical or surgical intervention. A number of adjuncts have been developed to supplement the consent process including multimedia tools. Unfortunately, there is little information regarding the use of Multimedia teaching tools (MMT) in pediatric settings in developing countries with diversities in language, socioeconomic and educational status. OBJECTIVES The objectives of the study were to compare the parental comprehension of the surgery through the informed consent obtained either by conventional method or by multimedia tool and the effect of MMT in alleviating parental anxiety against the conventional method and to assess their overall satisfaction. METHODS A randomized control trial was conducted between 2018 and 2020, including MMT and conventional groups. A novel Multimedia tool with a Microsoft PowerPoint presentation was created. A 5-Question knowledge-based test, State-Trait Anxiety Inventory (STAI) tool, and a Likert-based questionnaire were used to assess the comprehension, anxiety, and satisfaction of parents. RESULTS Among 122 randomized cohorts, the mean value of percentage fall in anxiety STAI score in the MMT group was 44.64 ± 10.14 whereas in the Conventional group it was 26.6 ± 11.91 (p < 0.05). MMT cohort scored higher in the knowledge-based test (p < 0.05) and recorded higher parental satisfaction. CONCLUSION The Multimedia tool aided consent procedure is effective in reducing parental anxiety and improving their comprehension and overall satisfaction. Thus, they can be used as an effective supplement in preoperative surgical education and consent procedure. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- K Shreyas
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Basni Phase 2 Industrial Area, Jodhpur, Rajasthan, 342001, India
| | - Avinash Jadhav
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Basni Phase 2 Industrial Area, Jodhpur, Rajasthan, 342001, India.
| | - Akhil D Goel
- Department of Community and Family Medicine, AIIMS, Jodhpur, India
| | - Manish Pathak
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Basni Phase 2 Industrial Area, Jodhpur, Rajasthan, 342001, India
| | - Kirtikumar Rathod
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Basni Phase 2 Industrial Area, Jodhpur, Rajasthan, 342001, India
| | - Shubhalaxmi Nayak
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Basni Phase 2 Industrial Area, Jodhpur, Rajasthan, 342001, India
| | - Rahul Saxena
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Basni Phase 2 Industrial Area, Jodhpur, Rajasthan, 342001, India
| | - Arvind Sinha
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Basni Phase 2 Industrial Area, Jodhpur, Rajasthan, 342001, India
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Brock J, Sale A, Jayaraju U, Chandetreya A, Lee P. A cost-consequence analysis of eLearning videos designed to supplement the consent process in lower limb arthroplasty. Ann R Coll Surg Engl 2023; 105:278-282. [PMID: 36260293 PMCID: PMC9974341 DOI: 10.1308/rcsann.2022.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION Since the Montgomery ruling in 2015 surgeons have been tasked with identifying material risk when taking informed consent. Despite this, there has been limited uptake of technological aids to supplement the consent process although such aids are shown to improve patient knowledge and satisfaction. ConsentPLUS is a free-to-access website with bite-sized educational videos designed to clearly explain lower limb arthroplasty procedures to patients and aid their consent. METHODS The authors performed a prospective cost-consequence analysis, outlining any costs associated with the intervention and any quantitative or qualitative impacts the intervention may have on patients. RESULTS A total of 3,143 consecutive patients were identified who were undergoing total knee or hip replacement in 25 elective NHS orthopaedic units. The total cost of development and projected 10-year running fees for ConsentPLUS total £75,000. Health Foundation support means the service is free-to-access for centres throughout the UK. Mean exposure time per patient was 10min 29s, equivalent to £185,437 of additional contact time according to the National Tariff. Mean clinic time was reduced by 17min owing to the earlier identification of material risk. Patient knowledge on pre- and post-video quizzes increased from 7.01 to 9.08 following eLearning (paired t-test = 0.998). The process had an overall satisfaction rate of 97%. CONCLUSION Educational eLearning videos are an accessible and digestible way to supplement the consent process. This enables earlier identification of material risk in clinics owing to improved patient knowledge, leading to increased patient satisfaction with arthroplasty consenting.
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Affiliation(s)
| | | | | | | | - P Lee
- Cwm Taf Morgannwg University Health Board, UK
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Bühn S, Huppertz E, Weise A, Lühnen J, Steckelberg A, Büchter RB, Hess S, Choi KEA, Mathes T. The effects of modifying elements of written informed consent forms for elective surgical or invasive procedures: A systematic review. PATIENT EDUCATION AND COUNSELING 2023; 107:107576. [PMID: 36455317 DOI: 10.1016/j.pec.2022.107576] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 11/05/2022] [Accepted: 11/18/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To study the effect of modifying content and design elements within written informed-consent-forms (ICF) for patients undergoing elective surgical or invasive procedures. METHODS We included (quasi-)randomized trials in which a modified written ICF (e.g. visual aids) was compared to a standard written ICF. We searched PubMed, Web-of-Science and PsycINFO until 08/2021. Risk of Bias was assessed. The complexity of intervention was assessed using the Intervention Complexity Assessment Tool for Systematic Reviews. RESULTS Eleven trials with 1091 participants were eligible. Effect sizes and levels of evidence varied from trivial to moderate andthere were contradictory findings for some outcomes. Providing patients with more informationin general or specific information on risks and complications mostly increased anxiety. The use of verbal risk presentation decreased anxiety and increased satisfaction.A lower readability level decreased anxiety and improved comprehension and knowledge. CONCLUSION Our results suggest that providing more information and addressing certain types of risks have differential effects. While more information improved knowledge, it also increased anxiety. We did not find any or only insufficient evidence for many other possible ICF modifications. PRACTICE IMPLICATIONS When developing ICFs the differential impact of different elements on patient important outcomes should be carefully considered.
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Affiliation(s)
- Stefanie Bühn
- Institute for Research in Operative Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.
| | - Elena Huppertz
- Institute for Research in Operative Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany; Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Medicine and University Hospital Cologne, Faculty of Human Sciences, University of Cologne, Germany
| | - Alina Weise
- Institute for Research in Operative Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Julia Lühnen
- Martin Luther University, Halle-Wittenberg; Interdisciplinary Center for Health Sciences; Institute of Health and Nursing Science, Halle (Saale), Germany
| | - Anke Steckelberg
- Martin Luther University, Halle-Wittenberg; Interdisciplinary Center for Health Sciences; Institute of Health and Nursing Science, Halle (Saale), Germany
| | - Roland Brian Büchter
- Institute for Research in Operative Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Simone Hess
- Institute for Research in Operative Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Kyung-Eun Anna Choi
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Fehrbelliner Straße 38, 16816 Neuruppin, Germany; Health Services Research, Research Center MIAAI, Faculty of Medicine/Dentistry, Danube Private University, Steiner Landstrasse 124, 3500 Krems-Stein, Austria
| | - Tim Mathes
- Institute for Research in Operative Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany; Department of Medical Statistics, University Medical Center Göttingen, Germany
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Atsaidis Z, Robitaille S, Guadagno E, Wiseman J, Emil S, Poenaru D. "Your child needs surgery": A survey-based evaluation of simulated expert consent conversations by key stakeholders. J Pediatr Surg 2023; 58:902-907. [PMID: 36828674 DOI: 10.1016/j.jpedsurg.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Consent conversations in pediatric surgery are essential components of pre-operative care which, when inadequate, can lead to significant adverse consequences for the child, parents, surgeon, and others in the healthcare system. The aim of this study is to explore expert consenting practice from the key stakeholders' perspective. METHODS Four senior attending pediatric surgeons obtained consent from a standardized mother of a child requiring surgery in two scenarios: a low-risk elective surgery (inguinal hernia repair - Video 1), and a high-risk emergency surgery (intestinal atresia - Video 2). All sessions were recorded. Families of children who had undergone minor or major surgery, families without medical or surgical background, and healthcare professionals were invited to view and evaluate the videos using a semi-structured questionnaire. RESULTS Out of 251 distributed surveys, 56 complete responses were received. Thirty two participants (57.1%) evaluated video 1 and 24 (42.9%) evaluated. Overall, 22 (69%) respondents to video 1 and 20 (84%) respondents to video 2 were "very satisfied" with the recorded consent conversation. Qualitative responses shared common themes of valuing surgeon empathy, good surgeon communication, patient engagement, and adequate time and information. Suggestions for improvement included additional resources and visual aids, improved patient engagement, and discussion of post-operative expectations. CONCLUSION Our data identifies strengths and gaps in the current consent process from the perspective of patient families and providers. Identified areas for improvement in the informed consent process based on multi-stakeholder input will guide the planned development of a consenting educational video resource. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Zoe Atsaidis
- McGill University Faculty of Medicine & Health Sciences, Montreal, Quebec, Canada.
| | - Stephan Robitaille
- Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Jeffrey Wiseman
- Division of Internal Medicine, McGill University Health Center, Montreal, Quebec, Canada
| | - Sherif Emil
- McGill University Faculty of Medicine & Health Sciences, Montreal, Quebec, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Dan Poenaru
- McGill University Faculty of Medicine & Health Sciences, Montreal, Quebec, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
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Selvarajan A, Arulanandam B, Guadagno E, Poenaru D. Family risk communication preferences in pediatric surgery: A scoping review. J Pediatr Surg 2023; 58:891-901. [PMID: 36822973 DOI: 10.1016/j.jpedsurg.2023.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Effective patient-surgeon communication is vital in pediatric surgical practice. However, family (including child) preferences for the format and content of risk communication information are largely unknown. In order to optimize the shared-decision making process, this scoping review explored the family-preferred methods for risk communication in pediatric surgery. METHODS A search was conducted in 7 databases from inception until June 2020 to identify family risk communication preferences in pediatric surgical patients, with language restricted to English and French. Two independent reviewers completed the screening in Rayyan software following PRISMA protocol. Included publications were reviewed for data extraction, analyzed, and assessed for risk of bias using standardized instruments. RESULTS A total of 6370 publications were retrieved, out of which 70 were included. Studies were predominantly from ENT (30.0%), general surgery (15.7%), and urology (11.4%). Family-preferred risk communication methods were classified as visual, verbal, technology-based, written, decision aids or other. Technological (32.4%) and written tools (29.7%) were most commonly chosen by families as their preferred risk communication methods. Written tools were frequently used in general surgery and urology, while technology-based tools were widely used in ENT. Most studies were cross-sectional and had a significant risk of bias. CONCLUSION Eliciting families' preferences for risk communication methods is critical for the implementation of shared decision-making. Different risk communication media appear to be preferred within specific surgical domains. To further improve shared-decision making in pediatric surgery, the development and usage of robust, validated risk communication tools are necessary. LEVEL OF EVIDENCE Level IV (Scoping Review).
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Affiliation(s)
- Arthega Selvarajan
- McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - Brandon Arulanandam
- McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dan Poenaru
- McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
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Understanding the effectiveness of consent processes and conversations in pediatric surgery: A systematic-scoping review. J Pediatr Surg 2022; 57:834-844. [PMID: 36031429 DOI: 10.1016/j.jpedsurg.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/21/2022] [Accepted: 08/03/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The consent conversation in pediatric surgery is an essential part of pre-operative care which, when inadequate, can lead to significant adverse consequences for the child, parents, surgeon, other healthcare workers and the healthcare system. We reviewed the published literature on what key stakeholders perceive are the components of effective and ineffective consenting processes in pediatric surgery. METHODS A medical librarian searched seven databases to retrieve articles looking at the informed consenting process in surgical care for the pediatric population. Two independent reviewers screened all publications and categorized them by stakeholder perspectives (patient/family, surgical team, other healthcare team, and hospital administration or policy maker). General study characteristics, interventions to improve consent and features of effective and ineffective consent conversations were extracted. RESULTS 5079 titles and abstracts were screened, resulting in 88 full-text studies and 43 articles included in the final review. Most publications (51%) discussed informed consent only from the patient/family perspective, while 21% added surgeon's perspective. No study approached the consenting process from the perspective of all stakeholder groups. Effective consent components identified included use of multimedia, presence of multiple conversations prior to surgery, and individualized communication catered to unique family knowledge and needs. In contrast, ineffective conversations did not include a clear assessment of parental understanding, delivered too much information, and did not address parental anxiety. CONCLUSIONS The literature on the consenting process in pediatric surgery is narrow in stakeholder perspectives. Our findings highlight gaps in the literature and opportunities to improve the informed consent processes prior to pediatric surgery.
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Evaluation of Patient Information Material in the Consent Process for Surgical Stabilization of Rib Fractures. J Trauma Nurs 2021; 28:310-315. [PMID: 34491948 DOI: 10.1097/jtn.0000000000000601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgical stabilization of rib fractures is a procedure carried out in most trauma centers; however, data on evaluation of patient information material regarding this procedure are limited. The trauma service at our hospital implemented slide presentation as an adjunct tool to the consenting process for patients undergoing this procedure. OBJECTIVE The aim was to evaluate information material for patients undergoing surgical stabilization of rib fractures procedure and subjective outcomes from education on components of knowledge, emotion, and behavior for patients undergoing this procedure. METHODS A one-group posttest prospective design study was conducted over 18 months at a Level I trauma center. Supplementary visual material was provided as an adjunct to the consent process of surgical rib fixation. Evaluation from the patient's perspective was undertaken utilizing the usefulness scale for patient information material. This tool was based on a tripartite model of reading, evaluating, and responding to patient information material. RESULTS Over the period of 18 months, 60 patients underwent surgical stabilization of rib fractures. Fifty-two (91.7%) patients reviewed the information material, and 41 (78.8%) patients completed the feedback. The results reflect that the majority of patients perceived positive responses in emotional support (M = 8.42, SD = 6.6); behavioral motivation (M = 8.57, SD = 6.4); and education on knowledge (M = 9.09, SD = 4.6). CONCLUSION In this novel study, visual aids as an adjunct to the informed consent process augmented patient knowledge regarding surgical stabilization of rib fractures and received positive subjective patient feedback on knowledge about the procedure.
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Spangler HD, Simancas-Pallares MA, Ginnis J, Ferreira Zandoná AG, Roach J, Divaris K. A Web-Based Rendering Application for Communicating Dental Conditions. Healthcare (Basel) 2021; 9:healthcare9080960. [PMID: 34442097 PMCID: PMC8393219 DOI: 10.3390/healthcare9080960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/19/2021] [Accepted: 07/24/2021] [Indexed: 11/16/2022] Open
Abstract
The importance of visual aids in communicating clinical examination findings or proposed treatments in dentistry cannot be overstated. Similarly, communicating dental research results with tooth surface-level precision is impractical without visual representations. Here, we present the development, deployment, and two real-life applications of a web-based data visualization informatics pipeline that converts tooth surface-level information to colorized, three-dimensional renderings. The core of the informatics pipeline focuses on texture (UV) mapping of a pre-existing model of the human primary dentition. The 88 individually segmented tooth surfaces receive independent inputs that are represented in colors and textures according to customizable user specifications. The web implementation SculptorHD, deployed on the Google Cloud Platform, can accommodate manually entered or spreadsheet-formatted tooth surface data and allows the customization of color palettes and thresholds, as well as surface textures (e.g., condition-free, caries lesions, stainless steel, or ceramic crowns). Its current implementation enabled the visualization and interpretation of clinical early childhood caries (ECC) subtypes using latent class analysis-derived caries experience summary data. As a demonstration of its potential clinical utility, the tool was also used to simulate the restorative treatment presentation of a severe ECC case, including the use of stainless steel and ceramic crowns. We expect that this publicly available web-based tool can aid clinicians and investigators deliver precise, visual presentations of dental conditions and proposed treatments. The creation of rapidly adjustable lifelike dental models, integrated to existing electronic health records and responsive to new clinical findings or planned for future work, is likely to boost two-way communication between clinicians and their patients.
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Affiliation(s)
- Hudson D. Spangler
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7450, USA; (M.A.S.-P.); (J.G.); (K.D.)
- Correspondence:
| | - Miguel A. Simancas-Pallares
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7450, USA; (M.A.S.-P.); (J.G.); (K.D.)
| | - Jeannie Ginnis
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7450, USA; (M.A.S.-P.); (J.G.); (K.D.)
| | | | - Jeff Roach
- Department of Research Computing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7032, USA;
| | - Kimon Divaris
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7450, USA; (M.A.S.-P.); (J.G.); (K.D.)
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7400, USA
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Use of visual aids in improving consent in maxillofacial surgery: A novel technique. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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13
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Metwally AM, Amer HA, Salama HI, Abd El Hady SI, Alam RR, Aboulghate A, Mohamed HA, Badran HM, Saadallah AA, El-Sonbaty MM, Eltahlawy E, Saad W, Mohsen A, Abdel-Latif GA, Fathy AM, Hassanain AI, Eldali A. Egyptian patients'/guardians' experiences and perception about clinical informed consent and its purpose: Cross sectional study. PLoS One 2021; 16:e0252996. [PMID: 34125842 PMCID: PMC8202917 DOI: 10.1371/journal.pone.0252996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 05/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Informed consent (IC) is a healthcare standard emphasizing the meaning of human dignity as clarified in the Universal Declaration of Human Rights. Data about IC practices in Egypt is insufficient. This study aimed to assess the Egyptian patients'/guardians' experiences about IC and their expectations about its practices' purposes in general and according to the type of the healthcare facility. METHODS Self-administered questionnaire was carried out for 1092 participants who had undergone or were scheduled to a procedure requiring an IC at three studied types for Egyptian health care facilities. Ten statements were ranked twice by the participants to reflect their perception of IC purpose as per what is currently practiced and what they believe should be practiced. RESULTS IC implementation varies significantly (p<0.05) across the health care facilities in Egypt. The percentage of its implementation at the non-governmental facilities, governmental facilities, and university hospital was 85.9%, 77.8%, and 63.8 respectively. The first three ranked purposes of the current IC practices were: "Helping patient/guardian decide (64.9%)", "Documenting patient's/guardian's decision (59.3%)", and "Having shared decision (57.3%)". The perceived purposes of IC to be practiced were: "Informing the patient/guardian (68.4%)", "Making sure patient/guardian understand (65.3%)" and "Documenting patients/guardians decisions (65.1%)". "Being a meaningless routine" was reported by the majority to be ranked as a low purpose for IC current and preferred practices. CONCLUSION The practice of IC is common within the Egyptian medical community. Participants believe that information disclosure "Making sure patients understand" has to help in IC decision making and its main purpose. However, unfortunately, this is not perceived as a current purpose of IC. There was consensus agreement that documenting the patient's/guardian's decision and informing the patient/guardian are perceived as both important current and preferred purposes for IC practices.
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Affiliation(s)
- Ammal M. Metwally
- Medical Research Division, Community Medicine Research Department, National Research Centre, Dokki, Cairo, Egypt
| | - Hala A. Amer
- Medical Research Division, Community Medicine Research Department, National Research Centre, Dokki, Cairo, Egypt
- Department of Infection Control, King Saud Medical City, Riyadh, KSA
| | - Hend I. Salama
- National Blood Transfusion Services Mansoura Region, Ministry of Health and Population, Egypt
| | | | - Raefa R. Alam
- Faculty of Nursing, Mansoura University, Mansoura, Egypt
- Egyptian Liver Research Institute And Hospital (ELRIAH), Mansoura, Egypt
| | - Ahmed Aboulghate
- Medical Research Division, Community Medicine Research Department, National Research Centre, Dokki, Cairo, Egypt
| | - Hanan A. Mohamed
- Faculty of Nursing, Mansoura University, Mansoura, Egypt
- Egyptian Liver Research Institute And Hospital (ELRIAH), Mansoura, Egypt
| | - Hanan M. Badran
- Faculty of Nursing, Mansoura University, Mansoura, Egypt
- Egyptian Liver Research Institute And Hospital (ELRIAH), Mansoura, Egypt
| | - Amal A. Saadallah
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Marwa M. El-Sonbaty
- Medical Research Division, Child Health Department, National Research Centre, Cairo, Egypt
- Department of Pediatrics, College of Medicine, Taibah University, Madinah, K.S.A
| | - Eman Eltahlawy
- Environmental Research Division, Environmental Health and Occupational Medicine, National Research Centre, Egypt
| | - Walaa Saad
- Department of biological anthropology, National Research Centre, Egypt, Cairo, Egypt
| | - Amira Mohsen
- Medical Research Division, Community Medicine Research Department, National Research Centre, Dokki, Cairo, Egypt
| | - Ghada A. Abdel-Latif
- Medical Research Division, Community Medicine Research Department, National Research Centre, Dokki, Cairo, Egypt
| | - Asmaa M. Fathy
- Medical Research Division, Community Medicine Research Department, National Research Centre, Dokki, Cairo, Egypt
| | - Amal I. Hassanain
- Medical Research Division, Child Health Department, National Research Centre, Cairo, Egypt
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Metwally AM, Amer HA, Salama HI, Abd El Hady SI, Alam RR, Aboulghate A, Mohamed HA, Badran HM, Saadallah AA, El-Sonbaty MM, Eltahlawy E, Saad W, Mohsen A, Abdel-Latif GA, Fathy AM, Hassanain AI, Eldali A. Egyptian patients’/guardians’ experiences and perception about clinical informed consent and its purpose: Cross sectional study. PLoS One 2021; 16:e0252996. [DOI: https:/doi.org/10.1371/journal.pone.0252996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Background
Informed consent (IC) is a healthcare standard emphasizing the meaning of human dignity as clarified in the Universal Declaration of Human Rights. Data about IC practices in Egypt is insufficient. This study aimed to assess the Egyptian patients’/guardians’ experiences about IC and their expectations about its practices’ purposes in general and according to the type of the healthcare facility.
Methods
Self-administered questionnaire was carried out for 1092 participants who had undergone or were scheduled to a procedure requiring an IC at three studied types for Egyptian health care facilities. Ten statements were ranked twice by the participants to reflect their perception of IC purpose as per what is currently practiced and what they believe should be practiced.
Results
IC implementation varies significantly (p<0.05) across the health care facilities in Egypt. The percentage of its implementation at the non-governmental facilities, governmental facilities, and university hospital was 85.9%, 77.8%, and 63.8 respectively. The first three ranked purposes of the current IC practices were: “Helping patient/guardian decide (64.9%)”, “Documenting patient’s/guardian’s decision (59.3%)”, and “Having shared decision (57.3%)”. The perceived purposes of IC to be practiced were: “Informing the patient/guardian (68.4%)”, “Making sure patient/guardian understand (65.3%)” and “Documenting patients/guardians decisions (65.1%)”. “Being a meaningless routine” was reported by the majority to be ranked as a low purpose for IC current and preferred practices.
Conclusion
The practice of IC is common within the Egyptian medical community. Participants believe that information disclosure “Making sure patients understand” has to help in IC decision making and its main purpose. However, unfortunately, this is not perceived as a current purpose of IC. There was consensus agreement that documenting the patient’s/guardian’s decision and informing the patient/guardian are perceived as both important current and preferred purposes for IC practices.
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Rai R, Landsberg A, Nguyen A, Wiseman SM. Online educational materials for appendectomy patients have good quality but poor readability. Am J Surg 2021; 221:1203-1210. [PMID: 33712262 DOI: 10.1016/j.amjsurg.2021.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/27/2021] [Accepted: 02/22/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Guidelines recommend patient health-related information be written at or below the sixth-grade level. This study evaluates the readability level and quality of online appendectomy patient education materials. METHODS Webpages were evaluated using seven readability formulae: Flesh-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), Automated Readability Index (ARI), Simple Measure of Gobbledygook (SMOG), Flesch Reading Ease (FRE), and New Dale-Chall (NDC). Two evaluators assessed quality using the Brief DISCERN tool. RESULTS Thirty seven webpages were analyzed. The mean readability scores were: FKGL = 9.11, GFI = 11.82, CLI = 10.84, ARI = 7.99, SMOG = 11.88, FRE = 51.17, and NDC = 5.48. 6 of the 7 readability formulae indicate that the materials were written at too high a level. The average Brief DISCERN score was 17.81, indicating good quality. CONCLUSIONS Readability levels for online appendectomy patient education materials are higher than recommended but are of good quality. Authors of such materials should not only provide good quality information but also ensure readability.
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Affiliation(s)
- Roopal Rai
- Department of Surgery, University of British Columbia & Paul's Hospital, C303 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.
| | - Adina Landsberg
- Department of Surgery, University of British Columbia & Paul's Hospital, C303 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.
| | - Anne Nguyen
- Department of Surgery, University of British Columbia & Paul's Hospital, C303 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.
| | - Sam M Wiseman
- Department of Surgery, University of British Columbia & Paul's Hospital, C303 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.
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Raper SE, Clapp JT, Fleisher LA. Improving Surgical Informed Consent: Unanswered Questions. ANNALS OF SURGERY OPEN 2021; 2:e030. [PMID: 37638239 PMCID: PMC10455139 DOI: 10.1097/as9.0000000000000030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/28/2020] [Indexed: 01/11/2023] Open
Abstract
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.
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Affiliation(s)
- Steven E. Raper
- From the Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Justin T. Clapp
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lee A. Fleisher
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Audiovisual Modules to Enhance Informed Consent in the ICU: A Pilot Study. Crit Care Explor 2020; 2:e0278. [PMID: 33251517 PMCID: PMC7685966 DOI: 10.1097/cce.0000000000000278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Obtaining informed consent for commonly performed ICU procedures is often compromised by variability in communication styles and inadequate verbal descriptions of anatomic concepts. The objective of this study was to evaluate the efficacy of an audiovisual module in improving the baseline knowledge of ICU procedures among patients and their caregivers. Design Prospective, observational study. Setting Forty-eight-bed adult surgical ICU at a tertiary care center. Subjects Critically ill surgical patients and their legally authorized representatives. Interventions An audiovisual module describing eight commonly performed ICU procedures. Measurements and Main Results Fifty-nine subjects were enrolled and completed an 11-question pre- and postvideo test of knowledge regarding commonly performed ICU procedures and a brief satisfaction survey. Twenty-nine percent had a healthcare background. High school was the highest level of education for 37% percent of all subjects. Out of 11 questions on the ICU procedure knowledge test, subjects scored an average 8.0 ± 1.9 correct on the pretest and 8.4 ± 2.0 correct on the posttest (p = 0.055). On univariate logistic regression, having a healthcare background was a negative predictor of improved knowledge (odds ratio, 0.185; 95% CI, 0.045-0.765), indicating that those with a health background had a lower probability of improving their score on the posttest. Among subjects who did not have a healthcare background, scores increased from 7.7 ± 1.9 to 8.3 ± 2.1 (p = 0.019). Seventy-five percent of all subjects indicated that the video was easy to understand, and 70% believed that the video improved their understanding of ICU procedures. Conclusions Audiovisual modules may improve knowledge and comprehension of commonly performed ICU procedures among critically ill patients and caregivers who have no healthcare background.
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An assessment of provider satisfaction with the use of a standardized visual aid for informed consent for appendectomy in children. J Pediatr Surg 2020; 55:913-916. [PMID: 32169339 DOI: 10.1016/j.jpedsurg.2020.01.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 01/25/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE We previously validated a visual aid for the use in the consent process for an appendectomy showing improved parental satisfaction and understanding. In this study, we evaluated provider satisfaction and perceived value of using the visual aid. METHODS An IRB approved survey was developed assessing provider experience with use of the visual aid. This was distributed and analyzed via Research Electronic Data Capture (RedCap) Database. RESULTS We administered 58 surveys (45% response rate). Participants included faculty (n = 2), fellows (n = 1), residents (n = 6), and physician assistants (n = 17). The visual aid was used >10 times by 50% of providers. The most common reason for not using the visual aid was not remembering it was available. Nearly half (40%) did not feel the visual aid added any time. 9/20 (45%) felt it added a small amount of time. Slightly over half of providers (52%) felt using the visual aid significantly increased family ability to give informed consent and made the consenting process easier for both providers and families. CONCLUSION Using a visual aid in consenting families for appendectomy does not add significant time and subjectively improves the process for providers and increases provider perception of parental understanding. LEVEL OF EVIDENCE Cost effectiveness, Level IV.
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Kearns C, Kearns N, Paisley AM. The art of consent: visual materials help adult patients make informed choices about surgical care. J Vis Commun Med 2019; 43:76-83. [PMID: 31799883 DOI: 10.1080/17453054.2019.1671168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Supporting patients in making informed healthcare decisions is a cornerstone of ethical medical practice. Surgeons frequently draw for and show images to patients when consenting them for operations but the value of this practice in informed decision-making is unclear. An audit was conducted in a General Surgery Department. 244 patients completed questionnaires on the value of visual materials when giving consent for surgery. The complexity of the operations was classified into "simple", "moderate" or "complex". 100% of patients felt they had given informed consent to surgery. 62% of patients received at least one form of visual material during the consenting process. All patients who received a drawing, and 99% of those provided with other images, valued these resources. Visual materials were considered more useful to patients when giving consent for moderate or complex operations than simple ones. Approximately one third of patients who did not receive visual materials would have appreciated these when making an informed decision. This research highlights the value of surgeons drawing for, and providing other visual resources to, their patients as part of the consent process. There is a role for further research and training materials in drawing skills for surgeons.
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Affiliation(s)
- Ciléin Kearns
- General Surgery Department, University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, Scotland.,General Surgery Department, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, Scotland.,General Surgery Department, Artibiotics, Wellington, New Zealand
| | - Nethmi Kearns
- Orthopaedic Surgery Department, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Anna M Paisley
- General Surgery Department, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, Scotland
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Adashek JJ, LoRusso PM, Hong DS, Kurzrock R. Phase I trials as valid therapeutic options for patients with cancer. Nat Rev Clin Oncol 2019; 16:773-778. [PMID: 31477881 DOI: 10.1038/s41571-019-0262-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 12/17/2022]
Abstract
For many years, oncology phase I trials have been referred to as 'toxicity trials' and have been believed to have low clinical utility other than that of establishing the adverse event profile of novel therapeutic agents. The traditional distinction of clinical trials into three phases has been challenged in the past few years by the introduction of targeted therapies and immunotherapies into the routine management of patients with cancer. This transformation has especially affected early phase trials, leading to the current situation in which response rates are increasingly reported from phase I trials. In this Perspectives, we highlight key elements of phase I trials and discuss how each one of them contributes to a new paradigm whereby preliminary measurements of the clinical benefit from a novel treatment can be obtained in current phase I trials, which can therefore be considered to have a therapeutic intent.
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Affiliation(s)
- Jacob J Adashek
- Department of Internal Medicine, University of South Florida, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - David S Hong
- Department of Investigational Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Razelle Kurzrock
- Center for Personalized Cancer Therapy, Department of Medicine, University of California San Diego Moores Cancer Center, La Jolla, CA, USA.
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Impact of a multimedia teaching tool on parental anxiety and knowledge during the informed consent process. Pediatr Surg Int 2018; 34:1345-1352. [PMID: 30255353 DOI: 10.1007/s00383-018-4352-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE Before performing a surgical procedure, informed consent (IC) is obtained. Parents may exhibit anxiety and/or a desire for more knowledge during the IC process for their child. The purpose of this study was to measure the impact of a multimedia intervention (MMI) versus conventional discussion on parental understanding and anxiety during the IC process for infants undergoing surgery for hypertrophic pyloric stenosis. METHODS A time-interrupted series design was employed over a 9-month period. In the first phase, conventional discussion for IC was performed. In the second phase, a MMI was utilized. In both phases, anxiety scores and post-consent knowledge tests were collected. RESULTS 31 participants were included in the study, 17 in the conventional consent and 14 in the MMI phase. Parental anxiety around the IC discussion was measured. There was a significant decrease in anxiety noted with use of the MMI (p = 0.046) but no significant difference in knowledge (p = 0.84). CONCLUSION The MMI significantly reduced parental anxiety during the IC process. Providers may consider applying this type of MMI to other surgical procedures. Securing IC in a manner that improves knowledge and decreases anxiety may improve long-term understanding and parental satisfaction with the health care process.
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