Computer may offer better way to get informed consent

NEW YORK (Reuters Health) - Using an interactive computer program to get patients' informed consent may help ensure that they actually understand the medical procedure they are agreeing to, a small study suggests.

Informed consent refers to the process by which a patient agrees to undergo a particular medical procedure, which includes discussing the procedure's risks and benefits with the doctor. But whether those discussions, even bolstered with written information, actually give patients a full understanding of the procedure has been in doubt.

In the new study, researchers at the University of Melbourne and Austin Hospital in Australia tested a computer-based informed consent process among 40 men scheduled to undergo surgery to remove the prostate gland.

The computer program included slides with animations detailing the procedure, its potential complications and the post-surgery recovery. Each slide contained questions for the patient to answer, and he could move on to the next slide only after he gave the correct responses.

Having patients answer questions helps turn the process into an "education and knowledge tool," according to Dr. Nathan Lawrentschuk, one of the researchers on the study, which appears in the urology journal BJU International.

It may also allow doctors and nurses to "hone in on areas not understood, rather than assuming our patients understand what we say," Lawrentschuk told Reuters Health in an email.

Patients in the current study were randomly assigned to either use the computer program or go through the standard consultation with their doctor. Immediately afterward, the patients answered a set of multiple-choice questions gauging their understanding of the surgery and its complications. The two groups then switched -- with those who'd received a standard consultation now using the computer program, and vice-versa -- and retook the multiple-choice test.

On average, the researchers found, patients who used the computer program gave correct responses to 78 percent of the test questions, versus 57 percent in the standard informed-consent group.

After the groups switched, patients who used the computer program improved their average score, while the other group maintained their scores.

"The implications are that we can use a simple tool to educate patients," Lawrentschuk said, noting that similar interactive computer programs should be relatively easy and inexpensive for medical centers to implement. The programs could also readily be put online in the future, he added.

Further studies, the researchers say, should look into ways to enhance such multimedia tools -- such as adding audio information, in a range of languages, and improving the visual content.

Computer-based inform consent, they add, might prove particularly useful when it comes to conveying the pros and cons of newer technologies, including robot-assisted prostate surgery.

The researchers note that one study found that patients were more likely to be "regretful and dissatisfied" with robot-assisted prostate surgery -- possibly because they had higher expectations of the high-tech, and often heavily-marketed, procedure.

SOURCE: BJU International, online March 19, 2010.