Tait Alan R, Voepel-Lewis Terri, Moscucci Mauro, Brennan-Martinez Colleen M, Levine Robert
Department of Anesthesiology, University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA.
Arch Intern Med. 2009 Nov 9;169(20):1907-14. doi: 10.1001/archinternmed.2009.390.
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.
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.
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).
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.
多项研究表明,患者及其家属对治疗的标准口头和书面同意信息的理解往往较差。本研究探讨了基于计算机的交互式信息程序对患者理解心脏导管插入术的影响。
计划接受诊断性心脏导管插入术的成年患者(n = 135)被随机分为两组,一组通过标准的机构口头和书面信息(SI)了解手术细节,另一组通过预先加载在笔记本电脑上的交互式计算机化信息(ICI)了解手术细节。在基线(即给予信息前)、心脏导管插入术后立即(早期理解)以及术后2周(晚期理解),通过半结构化访谈来测量理解情况。主要研究结果是两组从基线到早期理解的变化。
与接受SI的患者相比,随机接受ICI干预的受试者在理解方面有显著更大的改善(净变化,0.81;95%置信区间,0.01 - 1.6)。与SI组相比,ICI组中显著更多的受试者完全理解了心脏导管插入术的风险(53.6%对23.1%)(P = 0.001)以及治疗选择(63.2%对46.2%)(P = 0.048)。确定了几个理解改善的预测因素,包括基线知识(P < 0.001)、年龄较小(P = 0.002)和使用ICI(P = 0.003)。
结果表明,用于心脏导管插入术的基于计算机的交互式信息程序在提高患者理解方面可能比传统的书面同意信息更有效。因此,这项技术有望成为一种提供关于各种医疗治疗和程序的易懂详细信息的手段。