1st February 2019, Volume 132 Number 1489

Cameron Schauer, Tiffany Floyd, Jerry Chin, Alain C Vandal, Alex Lampen-Smith

Informed consent (IC) lies at the crux of patient-centred care in medicine. It affirms patient autonomy and should convey vital information, including the nature, risks, benefits and alternatives of a…

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Summary

Discussion prior to gastroscopy and colonoscopy, including risks and benefits is poorly done and usually varies widely between clinicians and hospitals. We attempted to use a video to improve this, but found that it did not change outcomes. Despite very poor recollection of what was discussed, patients in both the video and verbal explanation groups reported understanding of the procedure and satisfaction. Further work needs to be completed to improve this important process.

Abstract

Aim

Informed consent (IC) prior to endoscopy is often inconsistently and poorly performed. We compared use of video-assisted consent to standard verbal consent for enhancing patients’ recollection of procedural risks, understanding and fulfilment of expectation.

Method

Two hundred patients attending for gastroscopy or colonoscopy were randomised to either video-assisted consent (n=100) or verbal consent (n=100). The primary outcomes measured via a questionnaire were the recollection of procedural risks (sum of all correct answers for risk recall items) and patient experience compared to information provided in the consent process. Secondary outcomes included reported patient understanding and staff satisfaction between groups.

Results

There was no difference between video or verbal groups in terms of risk recall scores (p=0.46), with less than half the patients able to recall more than two risks. There was a signal towards improved recall of bleeding as a potential risk in the video as compared to the verbal arm but it did not reach statistical significance (p=0.059). Patients’ perceived understanding and fulfilment of expectation was high (>96%) in both groups. Seventy-one percent of the staff preferred using the video over the verbal IC.

Conclusion

Video-assisted consent made no significant difference to the IC process in terms of patient recollection or experience compared to usual verbal IC. Despite very poor recollection of procedural risks, patients in both the video and verbal groups reported understanding of the procedure and satisfaction with the IC process. Reasons for this mismatch are unclear. Further action to prioritise information delivery during IC is required. Future studies in this field should include patient-centred outcomes as a measure of success.

Author Information

Cameron Schauer, Gastroenterology Department, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga; Tiffany Floyd, Gastroenterology Department, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga; Jerry Chin, Gastroenterology Department, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga;
Alain Vandal, Senior Biostatistician, Ko Awatea, Counties Manukau District Health Board; Associate Professor, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland; Alex Lampen-Smith, Gastroenterology Department, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga.

Acknowledgements

We thank the Endoscopy Staff at Tauranga Hospital for their assistance in running this study. 

Correspondence

Cameron Schauer, C/O Gastroenterology Department, Tauranga Hospital, Private Bag 12024, Tauranga 3143.

Correspondence Email

cameron.schauer@gmail.com

Competing Interests

Nil.

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