Sowan Azizeh K, Beraya Arlienita R, Carrola Adrian, Reed Charles
School of Nursing, University of Texas Health at San Antonio, San Antonio, TX, United States.
University Health System, San Antonio, TX, United States.
JMIR Med Inform. 2018 Nov 28;6(4):e11056. doi: 10.2196/11056.
Informed consent is a complex process to help patients engage in care processes and reach the best treatment decisions. There are many limitations to the conventional consent process that is based on oral discussion of information related to treatment procedures by the health care provider. A conclusive body of research supports the effectiveness of multimedia patient decision aids (PtDAs) in the consent process in terms of patient satisfaction, increased knowledge about the procedure, reduced anxiety level, and higher engagement in the decision making. Little information is available about the effectiveness of multimedia PtDAs in the consent process of invasive therapeutic procedures such as the peripherally inserted central venous catheter (PICC).
The objective of this study was to examine the effectiveness of a multimedia PtDA in supplementing the consent process of the PICC for patients in 10 acute and intensive care units in terms of knowledge recall, knowledge retention, satisfaction with the consent process, and satisfaction with the PICC multimedia PtDA.
This pre-post quasi-experimental study included 130 patients for whom a PICC was ordered. Patients in the control group (n=65) received the conventional consent process for the PICC, while those in the intervention group (n=65) received the multimedia PtDA to support the consent process of a PICC. All patients were surveyed for knowledge recall and retention about the procedure and satisfaction with the consent process. Patients in the intervention group were also surveyed for their satisfaction with the multimedia PtDA.
Compared with the control group, patients in the intervention group scored around 2 points higher on knowledge recall (t=4.9, P<.001) and knowledge retention (t=4.8, P<.001). All patients in the intervention group were highly satisfied with the multimedia PtDA, with a mean score of >4.5 out of 5 on all items. Items with the highest mean scores were related to the effect of the multimedia PtDA on knowledge retention (mean 4.9 [SD 0.2]), patient readiness to learn (mean 4.8 [SD 0.5]), complete understanding of the procedure-related complications (mean 4.8 [SD 0.4]), and patient role in maintaining the safety of the PICC (mean 4.8 [SD 0.5]). Patients in the two groups were highly satisfied with the consent process. However, 15% (10/65) patients in the control group reported that the following information was omitted from the discussion: patient and provider roles in the safety of the PICC, other treatment options, and common side effects. Furthermore, 2 patients commented that they were not ready to engage in the discussion.
The multimedia PtDA is an effective standardized, structured, self-paced learning tool to supplement the consent process of the PICC and improve patient satisfaction with the process, knowledge recall, and knowledge retention.
知情同意是一个复杂的过程，旨在帮助患者参与医疗过程并做出最佳治疗决策。基于医护人员对与治疗程序相关信息进行口头讨论的传统同意程序存在许多局限性。大量确凿的研究支持多媒体患者决策辅助工具（PtDAs）在同意过程中的有效性，体现在患者满意度提高、对程序的了解增加、焦虑水平降低以及在决策过程中的参与度更高。关于多媒体PtDAs在诸如经外周静脉穿刺中心静脉置管（PICC）等侵入性治疗程序的同意过程中的有效性，可用信息较少。
本研究的目的是在10个急性和重症监护病房中，就知识回忆、知识保留、对同意过程的满意度以及对PICC多媒体PtDA的满意度，检验多媒体PtDA在补充PICC患者同意过程方面的有效性。
这项前后对照的准实验研究纳入了130例已下达PICC医嘱的患者。对照组（n = 65）的患者接受PICC的传统同意程序，而干预组（n = 65）的患者接受多媒体PtDA以支持PICC的同意过程。对所有患者进行了关于程序的知识回忆和保留情况以及对同意过程满意度的调查。干预组的患者还被调查了对多媒体PtDA的满意度。
与对照组相比：干预组患者在知识回忆（t = 4.9，P <.001）和知识保留（t = 4.8，P <.001）方面的得分高出约2分。干预组的所有患者对多媒体PtDA高度满意，所有项目的平均得分均>4.5（满分5分）。平均得分最高的项目与多媒体PtDA对知识保留的影响（平均4.9 [标准差0.2]）、患者学习准备度（平均4.8 [标准差0.5]）、对与程序相关并发症的完全理解（平均4.8 [标准差0.4]）以及患者在维护PICC安全中的作用（平均4.8 [标准差0.5]）有关。两组患者对同意过程都高度满意。然而，对照组中有15%（10/65）的患者报告称讨论中遗漏了以下信息：患者和医护人员在PICC安全中的作用、其他治疗选择以及常见副作用。此外，有2名患者表示他们未做好参与讨论的准备。
多媒体PtDA是一种有效的标准化、结构化、自主学习工具，可补充PICC的同意过程并提高患者对该过程的满意度、知识回忆和知识保留。
