Introducing iPad-Based Multimedia Education During Informed Consent for Image-Guided Breast Procedures
TALIAFERRO-DOCTOROFMEDICINETHESIS-2017.pdf (1.454Mb)(embargoed until: 2019-05-01)
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CitationTaliaferro, Andrew S. 2017. Introducing iPad-Based Multimedia Education During Informed Consent for Image-Guided Breast Procedures. Doctoral dissertation, Harvard Medical School.
AbstractPurpose: To determine whether multimedia education during informed consent for image-guided breast procedures improves patient understanding and experience.
Methods: 240 women having ultrasound-guided or stereotactic breast biopsy at Beth Israel Deaconess Medical Center were included in the study. Each was randomized to one of four study arms (A-D). Arm A consisted of standard paper informed consent by the radiology resident, fellow, nurse practitioner, or breast imaging attending. Arm B added informed consent on an iPad. Arm C added real-time review of the patient’s breast imaging. Arm D consisted of a prototype iPad application in which the patient watched an educational video discussing the standard informed consent followed by iPad consent. Objective understanding was assessed for all patients using the MacArthur Competency Assessment Tool for Treatment (MacCAT-T). Subjective patient experience, including anxiety, provider trust, and user experience with the multimedia was assessed through pre-consent, peri-consent, and post-procedure surveys. One-way ANOVA, Pearson’s r correlation, and chi-squared analysis was performed to evaluate for a difference between the 4 study arms.
Results: The mean age of study participants was 53.3 years ( 12.4 years SD). The study population to date was 59.6% White, 17.5% Black, 7.5% Hispanic, 12.1% Asian, 0.4% Pacific Islander, 1.7% Biracial, and 1.3% Other. 78.3% of patients spoke English and did not use an interpreter, and 21.7% of patients required an interpreter. There was no significant difference between study arms in MacCAT-T understanding summary rating among all patients (P = 0.19). Among all patients, patients in arm D were more likely to agree that the video improved their understanding of procedure steps than those in the imaging arm reported about the imaging presentation (2 = 9.8, P=0.04). Non-White patients in arm C reported improved subjective understanding (9.8 0.7 SD) than those in arm B (9.0 1.6 SD, P = 0.05). Non-White patients in arm C also reported improved overall experience (9.8 0.5 SD) compared to those in arm B (9.2 0.9 SD, P = 0.02). Non-English-speaking patients in arm C reported improved post-procedure comfort with the provider who performed the procedure (9.9 0.6 SD vs. 8.8 1.7 SD, P = 0.04) and overall experience (9.9 0.3 SD vs. 9.0 0.9 SD P < 0.01) than those in arm B. Non-White patients in arm B experienced increased anxiety between the pre-consent and peri-consent surveys (0.6 0.9 SD) as compared to those in arm A whose anxiety decreased between those two points in time (-0.2 1.1 SD, P = 0.03).
Conclusions: Viewing an informational procedure video detailing the benefits, risks, alternatives and steps of the procedure has no effect on objective patient understanding, but significantly improves subjective understanding of the steps of the procedure among all patients and overall patient experience among non-White patients. Review of imaging as part of the consent process significantly improves subjective understanding among non-White patients, as well as post-procedure comfort with the provider who performed the procedure and overall experience among non-English-speaking patients. Future studies should evaluate the utility of the informational procedure video during the informed consent process for image-guided breast procedures in patients who speak languages other than English.
Citable link to this pagehttp://nrs.harvard.edu/urn-3:HUL.InstRepos:32676113