The effect of multimedia interventions on the informed consent process for cataract surgery in rural South India

Abstract

Context:The provision of ocular surgical interventions for poorer, less educated populations is increasing as a result of increased globalization and outreach. However, these populations still have trouble understanding surgical concepts and are not always fully informed decision makers.Aims:We aimed to test the effect that a multimedia addition to a traditional verbal informed consent would have on patient comprehension of relatively difficult cataract surgical concepts.Settings and Design:We conducted a randomized controlled trial with relatively uneducated patients reporting to a private surgical hospital in Chennai, India. 47 patients were placed into the intervention group and 50 patients were placed into the control group.Materials and Methods:The intervention group was presented with a scripted verbal informed consent as well as a 3-fold pamphlet and a presentation with a 3-dimensional model of the eye. The control group was only presented with a scripted verbal informed consent. The two groups were tested using an 11 item “True/False/I don’t know” quiz directly before the informed consent, directly after the informed consent, and one-day postoperatively.Statistical Analysis Used:Scores on the quiz were compared across groups and time-points using paired t-tests.Results:Patients in the both groups showed a significant improvement in scores between pre- and post-informed consent quizzes (P value on the order of 10-6) and the improvement in scores was significantly greater in the intervention group than the control group (P value on the order of 10-16). There was no significant difference observed in either group with regards to the change in scores between post-informed consent and post-operative quizzes.Conclusion:Multimedia aids in addition to a standard informed consent process are effective in improving patient comprehension even for patients with low literacy and limited knowledge of surgical interventions.

Patient education strategies in cataract surgery: A systematic review

“…Other reasons for exclusion included: incompatible study population (not cataract surgery patients) ( n = 4), no relevant study intervention (patient education about cataract surgery) ( n = 3), language of publication other than English ( n = 2), and no available full‐text ( n = 1). From reference lists of the located articles, we identified two additional RCTs eligible for systematic review, yielding 16 studies in this review …”

“…In addition, seven (44%) of 16 trials included a description of educational status and literacy. Four of these trials were conducted in the developing world and described a largely uneducated, low‐literacy patient sample . Among the remaining three studies, Hill et al.…”

“…Only one of 16 (6.3%) studies indicated that the intervention being tested was based upon implementation of current clinical practice guidelines (current teaching by nurses at the institution) . Among the nine (56%) studies that reported the source of the intervention, four reported that ophthalmologists participated in educational design and approval . Two other studies reported that nursing clinicians presided over this entire process .…”

“…For studies measuring knowledge about cataracts and their treatment, assessment tools consisted of written questionnaires with variable lengths, scoring scales, contents, and question/answer formats (open‐ended vs. multiple‐choice vs. true/false). Moreover, we found considerable divergence with regard to timing of measurement: four studies included only preoperative measures, two studies included only postoperative measures and three studies measured patient understanding both preoperatively and postoperatively …”

Multimedia interventions on the informed consent process for cataract surgery

“…We read with interest the article by Karan et al . [ 1 ] describing the efficacy of multimedia interventions on the informed consent process for cataract surgery. The authors utilized multimedia aids during the informed consent process, providing patients with information on the surgical and postoperative procedure and general information regarding cataracts.…”