Ahead of leading a conversation about informed consent, clinicians who present patients with a simple 2-page handout can significantly strengthen patients’ grasp of the how’s and why’s behind an upcoming interventional radiology procedure.
What’s more, those who receive this type of patient decision aid, or PDA, tend to feel better heard and informed after the discussion than patients who have the talk without first reading the PDA.
Researchers found as much when they surveyed PDA recipients and non-recipients at two academic medical centers.
The American Journal of Roentgenology published their study online Sept. 21 [1]. First author is Shanmukha Srinivas, MD, of UC-San Diego. Senior and corresponding author is Eric Keller, MD, of Stanford University.
Consent Informed by Benefits, Risks and Options
The team first chose printed handouts over brief videos based on a focus group’s consensus preference. Next they prospectively enrolled 105 patients scheduled for either kidney ablation, liver ablation, lung ablation, inferior vena cava filter removal, transarterial chemoembolization, transarterial radioembolization or uterine fibroid embolization.
The researchers assigned PDA receipt or withholding systematically at one site and randomly at another.
The materials, emailed ahead of a scheduled informed consent discussion, described the benefits and risks of the upcoming procedures while also listing alternative care pathways.
The PDAs were written at a literacy level of sixth to eighth grade and vetted by patient focus groups reflecting racial, ethnic and age diversity.
Patient Decision Aids Encourage Questions, Enhance Answers
Following the informed consent conversations, the study group (59 males, 46 females, median age 67) completed a post-visit survey either online or over the phone.
Asked to rate statements by a 5-point Likert scale, respondents brought back mean ratings as follows:
- Patients who received the PDA, versus those who didn’t, reported better understanding of benefits (4.5 vs 4.0), risks (4.4 vs 3.6) and alternatives (4.0 vs 3.3), and of their procedure’s clinical particulars (4.4 vs 4.1).
- PDA recipients were more likely than non-recipients to feel they were given enough time with the clinician (4.7 vs 4.5), listened to carefully (4.8 vs 4.4), free to choose any option including not to have the procedure (4.7 vs 4.3) and allowed enough time to make a decision (4.8 vs 4.3).
- Recipients felt more encouraged to ask questions (4.8 vs 4.5) and to feel their questions were answered (4.8 vs 4.4).
No Extra Time or Effort Needed
In their discussion the authors state the study “demonstrates that providing patients with a well-vetted plain-language PDA before a consent conversation for an image-guided procedure significantly improves patients’ accuracy in describing the procedure, self-perceived understanding of the procedure, and satisfaction with and perception of the consent conversation.”
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"These benefits were achieved despite not requiring any additional time or effort by the clinicians performing the consent conversations. The findings indicate an approach to incorporating PDAs into clinical workflows that can enhance patients’ sense of empowerment in making decisions about their care.”
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.