Enhancing patient understanding of medical procedures: Evaluation of an interactive multimedia program with in-line exercises

https://doi.org/10.1016/j.ijmedinf.2014.01.011Get rights and content

Highlights

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    The interactive program resulted in greater understanding compared with the standard method.

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    Acceptance and utility of the interactive program were high.

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    In-line exercises with corrected feedback allowed real-time assessment of understanding.

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    Patients reported a preference for interactive programs for future medical information needs.

Abstract

Introduction

Standard print and verbal information provided to patients undergoing treatments are often difficult to understand and may impair their ability to be truly informed.

This study examined the effect of an interactive multimedia informational program with in-line exercises and corrected feedback on patients’ real-time understanding of their cardiac catheterization procedure.

Methods

151 adult patients scheduled for diagnostic cardiac catheterization were randomized to receive information about their procedure using either the standard institutional verbal and written information (SI) or an interactive iPad-based informational program (IPI). Subject understanding was evaluated using semi-structured interviews at baseline, immediately following catheterization, and 2 weeks after the procedure. In addition, for those randomized to the IPI, the ability to respond correctly to several in-line exercises was recorded. Subjects’ perceptions of, and preferences for the information delivery were also elicited.

Results

Subjects randomized to the IPI program had significantly better understanding following the intervention compared with those randomized to the SI group (8.3 ± 2.4 vs 7.4 ± 2.5, respectively, 0–12 scale where 12 = complete understanding, P < 0.05). First-time correct responses to the in-line exercises ranged from 24.3% to 100%. Subjects reported that the in-line exercises were very helpful (9.1 ± 1.7, 0–10 scale, where 10 = extremely helpful) and the iPad program very easy to use (9.0 ± 1.6, 0–10 scale, where 10 = extremely easy) suggesting good clinical utility.

Discussion

Results demonstrated the ability of an interactive multimedia program to enhance patients’ understanding of their medical procedure. Importantly, the incorporation of in-line exercises permitted identification of knowledge deficits, provided corrected feedback, and confirmed the patients’ understanding of treatment information in real-time when consent was sought.

Section snippets

Background

In order for patients to make informed treatment decisions they must be provided with pertinent information presented in a manner that promotes understanding [1]. Typically, this information is imparted either through a discussion with the physician, a paper consent form, or a combination of both. Unfortunately, the literature is replete with examples showing that patients often do not read conventional consent forms and/or have difficulty understanding the information provided [2], [3], [4],

Population

This study was approved by the University of Michigan's IRB with a waiver of written informed consent. Consecutive patients (>18 years) scheduled for diagnostic cardiac catheterization were enrolled. Patients who had undergone catheterization within the previous 5 years, those requiring emergency catheterization or stenting, and those who could not read were excluded. Patients were approached to participate at minimum 1 h prior to their procedure at a time when consent is normally sought.

Results

A total of 189 subjects were approached to participate in this study, of which 25 declined. Of those who declined, 52% were female, 92% Caucasian and the average age was 59.8 years suggesting that the non-respondents were not substantively different from the respondents. Six subjects withdrew following randomization (3 IPI and 3 SI). Of those in the SI group, 2 subjects were withdrawn because the procedure was canceled and 1 did not want to continue with the interviews. In the IPI group, 1

Discussion

Findings from this study confirmed those of others that interactive informational computer-based programs are well accepted and result in enhanced understanding and recall compared with traditional print-based medical information [20], [25], [26], [31]. Although there may be several explanations for these findings, one possible advantage of interactive programs is that they provide active participation in learning such that individuals become more “engaged” in the information compared with the

Author contributions

All authors qualify for authorship by substantial contributions to the research design and manuscript preparation. Dr. Tait led the evaluation of the program, analyzed the data, and wrote the manuscript. Drs. Voepel-Lewis and Chetcuti contributed to the design of the study, interpretation of the results, and reviewed and revised the manuscript drafts. Ms. Brennan-Martinez contributed to the design of the study, facilitated data collection, and reviewed drafts of the manuscript. Dr. Levine

Conflict of interest

Dr. Levine is the President and Chief Medical Officer and President of ArchieMD, Inc. but was funded independently for this project by a grant from the National Institutes of Health. Dr. Levine was responsible for the development of the interactive program and read the final manuscript but had no involvement in subject recruitment, data collection, scoring, statistical analysis, or interpretation of the data. None of the other investigators have any financial, commercial, or other interests in

Acknowledgements

Supported by a grant from the National Institutes of Health; NHLBI (2R42HL087488) to Dr. Levine. Dr. Tait was also supported by a grant from the National Institutes of Health, Bethesda MD (NICHD: R01HD053594). The sponsors had no involvement in the study design, analysis, interpretation, manuscript preparation, or decisions to submit the manuscript for publication.

Many thanks to Sarah Zyzanski, B.S., Katherine Bill, B.S., Adam Eickmeyer, Lamira Ray, Roneil Jackson, Cortney Segmen, for help with

References (49)

  • R. Barrett

    Quality of informed consent: measuring understanding among participants in oncology clinical trials

    Oncol. Nurs. Forum

    (2005)
  • T. Chan et al.

    Consenting to blood: what to patients remember

    Transfus. Med.

    (2005)
  • K. Engel et al.

    Patient comprehension of emergency department care and instructions: are patients aware of when they do not understand

    Ann. Emerg. Med.

    (2009)
  • D. McCormack et al.

    An evaluation of patients comprehension of orthopaedic terminology: implications for informed consent

    J. R. Coll. Surg. Edinb.

    (1997)
  • A.R. Tait et al.

    Do they understand? (part I): parental consent for children participating in clinical anesthesia and surgery research

    Anesthesiology

    (2003)
  • A.R. Tait et al.

    Do they understand? (part II): assent of children participating in clinical anesthesia and surgery research

    Anesthesiology

    (2003)
  • I. Rosique et al.

    The use and usefulness of information for patients undergoing anaesthesia

    Med. Law

    (2006)
  • J. Flory et al.

    Interventions to improve research participants’ understanding in informed consent for research

    JAMA

    (2004)
  • L. Jackson

    Information complexity and medical communication: the effects of technical language and amount of information in a medical message

    Health Commun.

    (1992)
  • P. Björn et al.

    Can the written information to research subjects be improved? An empirical study

    J. Med. Ethics

    (1999)
  • G. Dresden et al.

    Modifying a standard industry clinical trial consent form improves patient information retention as part of the informed consent process

    Acad. Emerg. Med.

    (2001)
  • A.R. Tait et al.

    Presenting research information to children: a tale of two methods

    Anesth. Analg.

    (2007)
  • A.R. Tait et al.

    Improving the readability and processability of a pediatric informed consent document: effects on parents’ understanding

    Arch. Pediatr. Adolesc. Med.

    (2005)
  • D. Young et al.

    Informed consent documents: increasing comprehension by reducing reading level

    IRB

    (1990)

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