Department of Surgery, Weill Cornell Medical College, New York, New York, USA.
Dis Esophagus. 2020 Jan 16;33(1). doi: 10.1093/dote/doz068.
The positive impact on patient comprehension and improved procedural outcomes when multimedia is utilized to convey instructions preprocedurally has been previously shown for gastrointestinal procedures such as colonoscopy. However, in gastroesophageal reflux testing (GERD), we continue to utilize verbal and written instructions to establish this diagnosis when we use BRAVO pH testing. This is arguably a more complex procedure involving stopping medications, placement of a device, and maintaining an accurate diary for the duration of the testing. We hypothesize that by utilizing multimedia to relay complex textual information, patients will have improved comprehension of periprocedural instructions thereby improving data entry and satisfaction of expectations during the procedure. Prospective randomized study of 120 patients undergoing endoscopic placement of the BRAVO pH monitoring capsule for evaluation of GERD receive either written preoperative instructions (control) or written plus video instructions (video group). A composite comprehension score was calculated using procedure-specific parameters of data entry over the 48-hour monitoring period. Patient satisfaction was evaluated on the basis of a five-point Likert scale. Extent of patient satisfaction was defined by the fulfillment of patient expectations. Exclusion criteria included patients who did not have access to the video or did not complete follow-up. Seventy-eight patients completed all follow-up evaluations. The video group (n = 44) had a significantly higher mean comprehension score when compared to the control group (n = 34) (9.6 ± 1.4 vs. 7.4 ± 2.0, P = 0.01). Overall satisfaction with instructions was significantly higher in the intervention group (91% vs. 47%, p 0.01). We detected no significant difference in comprehension or satisfaction scores in subgroup analyses of the video group comparing patients <65 and ≥65 years of age and by education level. Compared to standard written instructions, video instructions improved patient comprehension based on data evaluation, and satisfaction. Therefore, clinicians should consider incorporation of multimedia instructions to enhance patient periprocedural expectations and understanding of reflux pH testing using the BRAVO procedure.
在胃肠道程序（如结肠镜检查）中，先前已经证明了在术前使用多媒体传达说明对患者理解和改善程序结果有积极影响。然而，在胃食管反流测试（GERD）中，当我们使用 Bravo pH 测试来建立这个诊断时，我们仍然继续使用口头和书面说明。这可以说是一个更复杂的程序，涉及停止药物、放置设备以及在测试期间准确记录日记。我们假设通过利用多媒体传达复杂的文本信息，患者对围手术期说明的理解会得到提高，从而改善数据录入和程序期间的期望满意度。对 120 例接受内镜 Bravo pH 监测胶囊放置以评估 GERD 的患者进行前瞻性随机研究，这些患者接受书面术前说明（对照组）或书面加视频说明（视频组）。使用 48 小时监测期间特定程序的数据录入参数计算综合理解评分。基于 5 分李克特量表评估患者满意度。患者满意度的程度由患者期望的满足程度来定义。排除标准包括无法观看视频或未完成随访的患者。78 例患者完成了所有随访评估。与对照组（n = 34）相比，视频组（n = 44）的平均理解评分显著更高（9.6 ± 1.4 对 7.4 ± 2.0，P = 0.01）。干预组对说明的总体满意度明显更高（91%对 47%，p 0.01）。在视频组中，比较<65 岁和≥65 岁以及教育水平的亚组分析中，我们没有发现理解或满意度评分的显著差异。与标准书面说明相比，视频说明基于数据评估提高了患者的理解和满意度。因此，临床医生应考虑纳入多媒体说明，以增强患者围手术期对 Bravo 程序中反流 pH 测试的期望和理解。
