Bethune Allison, Davila-Foyo Marisol, Valli Mikaeel, da Costa Leodante
From the Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. (Bethune, Costa, Davila-Foyo); and the Institute of Medical Sciences, University of Toronto, Toronto, Ont. (Valli).
Can J Surg. 2018 Oct 1;61(5):339-344. doi: 10.1503/cjs.016017.
Patient recall of information about procedures, including risks and benefits and potential outcomes, is often insufficient. We sought to determine whether a multimedia educational tool enhances the informed consent discussion for elective neurosurgical procedures by increasing patient knowledge of the procedure.
Adult patients from a single neurosurgical site eligible for 4 neurosurgical procedures (lumbar spine or cervical spine decompression for degenerative disease, craniotomy for brain tumour or trigeminal neuralgia treatment) were offered enrolment. Patients were randomly assigned to either the control arm (standard consent discussion) or the intervention arm (review of an e-book containing information tailored to their disease/injury plus standard consent discussion). Participants completed a 14-item questionnaire before and after the consent discussion.
Questionnaires were completed by 38 participants, 18 in the control group and 20 in the intervention group. The mean age was 62.2 (standard deviation [SD] 13.6) years and did not differ significantly between the 2 groups. The mean baseline questionnaire scores were similar for the control and intervention groups (20.4 [SD 7.3] v. 20.6 [SD 6.7]). However, the mean scores on the follow-up questionnaire were significantly different between the 2 groups (20.2 [SD 4.0] v. 23.2 [SD 4.9], = 0.02). There was no change in the scores on the 2 questionnaires in the control group, whereas, in the intervention group, the mean score was significantly higher after the intervention ( = 0.03).
The use of an electronic booklet appears to improve patients’ knowledge of their surgical procedure. The use of multimedia booklets in clinical practice could help standardize and optimize the consent process, ensuring that patients receive the relevant information to make a truly informed decision.
患者对手术相关信息的回忆，包括风险、益处及潜在结果，往往并不充分。我们试图确定一种多媒体教育工具是否能通过增加患者对手术的了解，来加强择期神经外科手术的知情同意讨论。
来自单一神经外科站点、符合4种神经外科手术（因退行性疾病行腰椎或颈椎减压术、因脑肿瘤或三叉神经痛行开颅手术）条件的成年患者可报名参加。患者被随机分配至对照组（标准同意讨论）或干预组（阅读一本针对其疾病/损伤定制信息的电子书并加上标准同意讨论）。参与者在同意讨论前后完成一份14项的问卷。
38名参与者完成了问卷，其中对照组18名，干预组20名。平均年龄为62.2（标准差[SD]13.6）岁，两组间无显著差异。对照组和干预组的平均基线问卷得分相似（20.4[SD 7.3]对20.6[SD 6.7]）。然而，两组随访问卷的平均得分有显著差异（20.2[SD 4.0]对23.2[SD 4.9]，P = 0.02）。对照组两份问卷的得分无变化，而干预组干预后的平均得分显著更高（P = 0.03）。
使用电子手册似乎能提高患者对其手术的了解。在临床实践中使用多媒体手册有助于规范和优化同意过程，确保患者获得相关信息以做出真正知情的决定。
