Patient comprehension of an interactive, computer-based information program for cardiac catheterization: a comparison with standard information.

BACKGROUND Several studies suggest that standard verbal and written consent information for treatment is often poorly understood by patients and their families. The present study examines the effect of an interactive computer-based information program on patients' understanding of cardiac catheterization. METHODS Adult patients scheduled to undergo diagnostic cardiac catheterization (n = 135) were randomized to receive details about the procedure using either standard institutional verbal and written information (SI) or interactive computerized information (ICI) preloaded on a laptop computer. Understanding was measured using semistructured interviews at baseline (ie, before information was given), immediately following cardiac catheterization (early understanding), and 2 weeks after the procedure (late understanding). The primary study outcome was the change from baseline to early understanding between groups. RESULTS Subjects randomized to the ICI intervention had significantly greater improvement in understanding compared with those who received the SI (net change, 0.81; 95% confidence interval, 0.01-1.6). Significantly more subjects in the ICI group had complete understanding of the risks of cardiac catheterization (53.6% vs 23.1%) (P = .001) and options for treatment (63.2% vs 46.2%) (P = .048) compared with the SI group. Several predictors of improved understanding were identified, including baseline knowledge (P < .001), younger age (P = .002), and use of the ICI (P = .003). CONCLUSIONS Results suggest that an interactive computer-based information program for cardiac catheterization may be more effective in improving patient understanding than conventional written consent information. This technology, therefore, holds promise as a means of presenting understandable detailed information regarding a variety of medical treatments and procedures.

[1]  Sandra van Dulmen,et al.  Interventions to improve recall of medical information in cancer patients: a systematic review of the literature , 2008, Psycho-oncology.

[2]  E. Winer,et al.  Understanding the decisions of cancer clinical trial participants to enter research studies: factors associated with informed consent, patient satisfaction, and decisional regret. , 2006, Patient education and counseling.

[3]  I. Chin-Yee,et al.  Consenting to blood: what do patients remember? , 2005, Transfusion medicine.

[4]  T. Kessler,et al.  Patients' perception of preoperative information by interactive computer program-exemplified by cholecystectomy. , 2005, Patient education and counseling.

[5]  Roseann Barrett,et al.  Quality of informed consent: measuring understanding among participants in oncology clinical trials. , 2005, Oncology nursing forum.

[6]  Michael J Rossi,et al.  Video informed consent improves knee arthroscopy patient comprehension. , 2005, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[7]  Terri Voepel-Lewis,et al.  Improving the readability and processability of a pediatric informed consent document: effects on parents' understanding. , 2005, Archives of pediatrics & adolescent medicine.

[8]  James Flory,et al.  Interventions to improve research participants' understanding in informed consent for research: a systematic review. , 2004, JAMA.

[9]  Baljean Dhillon,et al.  Cataract surgery and consent: Recall, anxiety, and attitude toward trainee surgeons preoperatively and postoperatively , 2004, Journal of cataract and refractive surgery.

[10]  Terri Voepel-Lewis,et al.  Participation of Children in Clinical Research: Factors that Influence a Parent's Decision to Consent , 2003, Anesthesiology.

[11]  Terri Voepel-Lewis,et al.  Do They Understand? (Part I): Parental Consent for Children Participating in Clinical Anesthesia and Surgery Research , 2003, Anesthesiology.

[12]  Patrick Heagerty,et al.  Randomized, Controlled Evaluation of a Prototype Informed Consent Process for HIV Vaccine Efficacy Trials , 2003, Journal of acquired immune deficiency syndromes.

[13]  M Hermann,et al.  [3-dimensional computer animation--a new medium for supporting patient education before surgery. Acceptance and assessment of patients based on a prospective randomized study--picture versus text]. , 2002, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.

[14]  Peter Tugwell,et al.  A randomized trial of a computerized versus an audio-booklet decision aid for women considering post-menopausal hormone replacement therapy. , 2002, Patient education and counseling.

[15]  M. Hermann,et al.  Dreidimensionale Computeranimation – neues Medium zur Unterstützung des Aufklärungsgesprächs vor Operationen Akzeptanz und Bewertung der Patienten anhand einer prospektiv randomisierten Studie – Bild versus Text , 2002, Der Chirurg.

[16]  C. McHorney,et al.  Frequency or Probability? A Qualitative Study of Risk Communication Formats Used in Health Care , 2001, Medical decision making : an international journal of the Society for Medical Decision Making.

[17]  T. Voepel-Lewis,et al.  Parents’ preferences for participation in decisions made regarding their child’s anaesthetic care , 2001, Paediatric anaesthesia.

[18]  M. Levitt,et al.  Modifying a standard industry clinical trial consent form improves patient information retention as part of the informed consent process. , 2001, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[19]  T. Beebe,et al.  A Randomized, Controlled Trial of Interactive, Multimedia Software for Patient Colonoscopy Education , 2001, Journal of clinical gastroenterology.

[20]  V. Strecher,et al.  Quit for keeps: tailored smoking cessation guides for pregnancy and beyond , 2000, Tobacco control.

[21]  Deborah Lewis,et al.  Review: Computer-based Approaches to Patient Education: A Review of the Literature , 1999, J. Am. Medical Informatics Assoc..

[22]  J. G. Hollands,et al.  The visual communication of risk. , 1999, Journal of the National Cancer Institute. Monographs.

[23]  T. Voepel-Lewis,et al.  Factors that influence parents' decisions to consent to their child's participation in clinical anesthesia research. , 1998 .

[24]  E A Balas,et al.  Clinical trials of interactive computerized patient education: implications for family practice. , 1997, The Journal of family practice.

[25]  R. Barbarash,et al.  The Deaconess Informed Consent Comprehension Test: An Assessment Tool for Clinical Research Subjects , 1996, Pharmacotherapy.

[26]  N. Aaronson,et al.  Telephone-based nursing intervention improves the effectiveness of the informed consent process in cancer clinical trials. , 1996, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[27]  V. Strecher,et al.  The effects of computer-tailored smoking cessation messages in family practice settings. , 1994, The Journal of family practice.

[28]  K D Hopper,et al.  Interactive method of informing patients of the risks of intravenous contrast media. , 1994, Radiology.

[29]  R. Kurtz,et al.  A randomized trial using videotape to present consent information for colonoscopy. , 1994, Gastrointestinal endoscopy.

[30]  V. Strecher,et al.  Physicians' recommendations for mammography: do tailored messages make a difference? , 1994, American journal of public health.

[31]  E. J. Mayeaux,et al.  Rapid estimate of adult literacy in medicine: a shortened screening instrument. , 1993, Family medicine.

[32]  D. Byrne,et al.  How informed is signed consent? , 1988, British medical journal.

[33]  C. F. Kao,et al.  The efficient assessment of need for cognition. , 1984, Journal of personality assessment.

[34]  B. Cassileth,et al.  Informed consent -- why are its goals imperfectly realized? , 1980, The New England journal of medicine.

[35]  T. Beauchamp,et al.  Principles of biomedical ethics , 1991 .