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

Abstract

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-today 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.

The effectiveness of video animations as information tools for patients and the general public: A systematic review

“…Cartoon animations were used in 29 studies, on the subject of: kidney donation ( 20 ); post-surgery rehabilitation ( 21 ); contraception ( 22 ); Type 2 diabetes ( 23 ); use of opioids ( 24 ); acute coronary syndrome and maintaining heart health ( 25 ); polio vaccination ( 9 ); thyroid surgery ( 26 ) in one arm; chronic constipation ( 27 ); liver fluke ( 28 ); cardio-pulmonary resuscitation (CPR) ( 29 ); consent to CT scanning ( 19 ); colorectal cancer screening ( 30 , 31 ); preparation for preparation for surgery ( 13 , 32 ), or skin surgery ( 33 , 34 ), or angiography ( 35 ); sputum testing ( 36 ); prevention of thalassemia ( 37 ); early medical abortion ( 38 ); lung cancer screening ( 39 ); medicines for epilepsy ( 40 ); preventive dental care ( 41 ); stem cell transplantation ( 42 ); appropriate antibiotic use ( 8 ); consent for cystoscopy ( 43 ); lumbar puncture ( 44 ).…”

“…spoken information) ( 13 , 34 , 40 ); booklet ( 32 , 39 ); standard written and spoken information ( 42 , 49 ); nurse education audio-recording ( 20 ). In 23 trials the animation was provided as an alternative to control group interventions, which were: spoken information ( 19 , 21 , 33 ); standard care ( 35 , 36 , 38 ); easy-to-read written information ( 24 , 53 ); static images ( 31 , 45 ); either diagram or 3D model, according to allocation ( 26 ); written booklet ( 8 , 18 , 27 , 47 , 48 ); printed information ( 9 , 50 ); booklets, posters and spoken information ( 28 ); live instructions provided by phone ( 29 ); audio-booklet or static images, according to allocation ( 30 ); peer education or conventional lecture, according to allocation ( 37 ); Tell-Show-Do technique ( 41 ); verbal consent following provision of spoken information ( 43 ). In one trial ( 51 ) the animation was provided as an alternative to the standard physician-patient consent conversation in one trial arm, and in addition to it in another trial arm.…”

“…Knowledge was the most commonly reported outcome in 30 trials ( 8 , 9 , 13 , 18 – 21 , 23 – 25 , 27 , 28 , 30 – 33 , 35 , 37 – 40 , 43 – 45 , 47 – 52 ).…”

“…Attitudes and cognitions were reported in 20 trials, reporting self-efficacy ( 20 ); information satisfaction ( 18 , 32 , 33 , 38 , 42 – 44 , 47 – 49 , 51 ); illness perceptions ( 25 ); perceptions of surgery, quality of recovery ( 46 ); information satisfaction, unmet information needs ( 26 ); information satisfaction, familiarity with topic ( 19 ); desire for information ( 34 ); self-care confidence ( 52 ); attitude to information ( 50 ); subjective knowledge, decisional certainty ( 39 ); information satisfaction, having learned from information ( 8 ).…”

“…Nine of the 17 studies were assessed as having a high risk of bias, most commonly due to the randomisation process. The other studies were rated as at low risk of bias (3 studies) ( 36 , 43 , 48 ) or having “some concerns” (5 studies), due to small sample sizes or a lack of protocol registration ( 33 , 38 , 41 , 42 , 49 ).…”