Developing, Implementing, and Evaluating a Multimedia Patient Decision Aid Program to Reform the Informed Consent Process of a Peripherally Inserted Central Venous Catheter Procedure: Protocol for Quality Improvement 

Abstract

BackgroundInformed consent has considerable clinical, ethical, and legal implications for patient safety and liability. Little information is available about the use of multimedia patient decision aids (PtDA) in the consent process for therapeutic invasive procedures such as the peripherally inserted central venous catheter (PICC). In addition, none of the available studies have designed their multimedia PtDAs based on the Agency for Healthcare Research and Quality’s (AHRQ) comprehensive guide for informed consent.ObjectiveThis paper describes a patient-centered, systematic, multidisciplinary approach to develop, implement, and alpha test a multimedia PtDA to reform the informed consent process of a PICC for patients in 10 acute and intensive care units.MethodsThe development, implementation, and evaluation processes of the PtDA followed the phases in the Multimedia Production Framework: preproduction, production, and postproduction. Within this framework, we applied the criteria for judging the quality of PtDAs, the AHRQ’s Health Literacy Universal Precautions Toolkit, and the AHRQ’s Patient Education Materials Assessment Tool Guide. The methodology was guided by the Interprofessional Shared Decision-Making Model and the AHRQ’s Making Informed Consent an Informed Choice guide. In the preproduction phase, we (1) reviewed the current consent form; (2) observed 18 consent processes; (3) surveyed the vascular access team (N=6 nurses) about their perception of the current process; (4) surveyed 30 patients for knowledge recall and retention, overall satisfaction, and attitude toward using a multimedia PtDA; and (5) wrote and reviewed the script for the multimedia program. The production phase focused on filming the PtDA in English and Spanish languages. The postproduction phase included integrating the multimedia programs into the care processes, developing a modified workflow for the consent process, and alpha testing of the English and Spanish PtDAs by (1) a group of 5 patients for clarity and understandability of the information; (2) nurses using the AHRQ’s Patient Education Materials Assessment Tool Audio and Video; and (3) by the multidisciplinary change team.ResultsBased on the alpha testing, patients indicated that the content was easy to follow and read; nurses provided positive feedback, and their comments were mainly related to the changes in the workflow in the consent process of the PICC after using the PtDA; and the multidisciplinary change team suggested edits related to changing a few scenes. The final multimedia program consisted of 7 min and 37 s demonstrating detailed information about the PICC.ConclusionsA systematic development of PtDAs for nonurgent invasive procedures may eliminate many limitations of the conventional consent process by ensuring comprehensive, standardized, and easy-to-comprehend information and providing sufficient time for the patients to reflect on the information. To be effective, PtDAs should follow a systematic, patient-centered, evidence-based, and rigorous approach in the ...

Effect of video-assisted education on informed consent and patient education for peripherally inserted central catheters: a randomized controlled trial

“…This tendency to prefer video education to face-to-face information reflects the findings of Sowan et al. 8 …”

“…Additionally, two patients in the control group reported they were not ready for a face-to-face consent discussion and would like to view the video material to prepare themselves for the discussion. This tendency to prefer video education to face-to-face information reflects the findings of Sowan et al 8 Video-assisted systems can help patients obtain more information and improve patient retention of PICC-related information. 6,16 Our findings show that videoassisted informed consent did not reduce or improve patient retention of PICCrelated information, possibly because the score of both groups was already high, especially for items patients are most concerned about, such as indwelling time, activity, considerations when taking a shower and catheter fracture.…”

Effect of a Multimedia Patient Decision Aid to Supplement the Informed Consent Process of a Peripherally Inserted Central Venous Catheter Procedure: Pre-Post Quasi-Experimental Study

“…After the creation of the multimedia PtDA for the PICC, the PtDA was integrated into the EMR and delivered to patients using GetWell Inpatient [16]. GetWell Inpatient is a patient education and entertainment system that is integrated into the EMR and used to distribute and track the use of educational videos and multimedia programs in addition to other purposes related to engaging patients in care processes [16]. The use of the PICC multimedia PtDA to supplement the PICC consent process resulted in workflow redesign, as described previously [16].…”

“…GetWell Inpatient is a patient education and entertainment system that is integrated into the EMR and used to distribute and track the use of educational videos and multimedia programs in addition to other purposes related to engaging patients in care processes [16]. The use of the PICC multimedia PtDA to supplement the PICC consent process resulted in workflow redesign, as described previously [16]. One of the major changes was related to the new coordination between bedside nurses from the ACUs and ICUs and nurses from the vascular access team.…”

“…In a previous study, we described the process of developing and “alpha” testing a multimedia PtDA for the PICC following a multidisciplinary, patient-centered, and systematic process [16]. The process was based on the Agency for Healthcare Research and Quality’s (AHRQ) Guide for Making Informed Consent an Informed Choice [17], the AHRQ’s Health Literacy Universal Precautions Toolkit Guide [18], and the AHRQ’s Patient Education Materials Assessment Tool Guide for Audio/Video Materials [19].…”