Department of Neurosurgery, University Hospital Basel, University of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland.
Acta Neurochir (Wien). 2024 Nov 15;166(1):455. doi: 10.1007/s00701-024-06355-w.
With the growing demand for shared decision-making and patient-centered care, optimal informed consent (IC) has gained relevance. Virtual reality (VR) has seen significant technological advancements, and its medical applications currently include surgical planning and medical education. This pilot study investigates the feasibility of VR-enhanced informed consent (VR-IC) in neurosurgery to improve preoperative IC and patient satisfaction.
We included patients aged 18 to 75 years who were scheduled for skull base meningioma or brain aneurysm surgery between May and December 2023. Exclusion criteria were visual/auditory impairments and severe cognitive/psychiatric disorders. Patients received standard IC followed by VR-IC using patient-specific VR models of their pathology. After an initial demonstration by the surgeon, the patients used the VR station independently. A questionnaire with 18 questions on a 5-point Likert scale assessed the subjective impression of VR-IC.
Ten patients participated in the study, with six (60%) undergoing aneurysm clipping and four (40%) undergoing skull base meningioma resection. The mean age of the participants was 58 years (± 15, range 27 to 75 years), with four female patients (40%). Patients overall rated the VR-informed consent (VR-IC) positively with a mean of 4.22 (± 0.84). There was a better understanding of their pathology (mean 4.30 ± 0.92) and the planned procedure (mean 3.95 ± 1.04). Trust in the surgeon was rated with a mean of 3.47 (± 0.94). Only minimal side effects from the VR experience including dizziness or discomfort were noted (mean 4.60 ± 0.22). None of the participants dropped out of the study.
VR-enhanced informed consent is feasible and improves patient understanding and satisfaction without significant side effects. These findings will guide the planning of a randomized controlled trial to validate the benefits of VR-IC in neurosurgery further.
随着对共同决策和以患者为中心的护理的需求不断增长，最佳知情同意（IC）变得越来越重要。虚拟现实（VR）技术取得了重大进展，其医疗应用目前包括手术规划和医学教育。本研究旨在探讨神经外科中增强型 VR 知情同意（VR-IC）在改善术前 IC 和患者满意度方面的可行性。
我们纳入了 2023 年 5 月至 12 月期间计划接受颅底脑膜瘤或脑动脉瘤手术的 18-75 岁患者。排除标准为视觉/听觉障碍和严重认知/精神障碍。患者接受标准知情同意后，使用患者特定的病理学 VR 模型进行 VR-IC。在外科医生进行初步演示后，患者可独立使用 VR 工作站。一份包含 18 个问题的问卷，每个问题采用 5 级 Likert 量表进行评估，用于评估 VR-IC 的主观印象。
共有 10 名患者参与了研究，其中 6 名（60%）接受动脉瘤夹闭术，4 名（40%）接受颅底脑膜瘤切除术。参与者的平均年龄为 58 岁（±15 岁，范围 27-75 岁），女性 4 名（40%）。总体而言，患者对 VR 知情同意（VR-IC）的评价为 4.22（±0.84）。他们对自己的病情（平均 4.30±0.92）和计划的手术（平均 3.95±1.04）有了更好的理解。对外科医生的信任度评分为 3.47（±0.94）。只有少数患者报告了 VR 体验的轻微副作用，包括头晕或不适（平均 4.60±0.22）。没有患者退出研究。
增强型 VR 知情同意是可行的，可提高患者的理解和满意度，且无明显副作用。这些发现将指导进一步验证神经外科中 VR-IC 益处的随机对照试验的规划。
