Seeing is Believing: Empowering Patients Through Video Education. A RCT Evaluating a Multimedia Video for Patients Undergoing TLH.

Introduction: Informed consent is imperative to the delivery of safe patient‐centred care. Unfortunately, patients’ recollection is often low.1 Multimedia videos have been demonstrated to improve informed consent by increasing knowledge without increasing patient anxiety.2‐3 This has been incompletely evaluated in patients undergoing a laparoscopic hysterectomy. Study Objective: To compare the use of a supplementary multimedia video with routine clinician consent in improving the informed consent process for patients undergoing a total laparoscopic hysterectomy (TLH). Design: Prospective randomized controlled trial. Setting: Tertiary teaching hospital. Patients or Participants: 18 years or above, English‐speaking, awaiting a TLH for benign indications. Interventions: Participants were assessed on their baseline understanding of their procedure with a knowledge questionnaire. All participants received standard verbal consent from a surgeon. Participants were then randomized. The video group (intervention group) watched a supplementary video describing the surgery. Both groups repeated the knowledge questionnaire, and completed a satisfaction survey and modified State‐Trait Anxiety Inventory (STAI). These were repeated at 4 weeks to assess knowledge retention. Measurements and Main Results: From 25/7/2022 to 01/12/2023, 45 patients were randomised. 4 patients were excluded due to a missing baseline questionnaire, or surgery occurring before video intervention. A total of 41 patients were included in final analysis: 20 patients in the control group and 21 patients in the video group. The mean age was 44.8 (range 28.0 – 58.0). There were no statistical differences between the groups in baseline demographics including age, occupation, education levels and surgical history. Survey scores were analysed using the Wilcoxon Rank‐Sum nonparametric test. No significant difference was observed in the baseline knowledge score between groups. The video group scored significantly higher in the second knowledge questionnaire following the intervention (p <0.01), with median scores of 8.0 and 10.0 (IQR 5.4 – 9.6; 9.0 – 12.0) in the control and video group respectively. The score difference between the baseline questionnaire and second questionnaire was significantly higher in the video group (p<0.01) with a median score improvement of 5 points (p<0.01; IQR 3.7 – 5.0). There were no significant differences in the STAI scores or the 4 week knowledge survey scores between groups. Within the constraints of our sample size, a linear regression model revealed that none of the attributes had a strong influence on the knowledge questionnaire scores. Conclusion: A multimedia video may enhance routine pre‐operative counselling for patients undergoing laparoscopic hysterectomy by increasing knowledge recall around the procedure, without increasing levels of anxiety. 1. Sherlock A, Brownie S. Patients' recollection and understanding of informed consent: a literature review. ANZ J Surg. 2014 Apr;84(4):207‐10. 2. Farrell EH, Whistance RN, Phillips K, Morgan B, Savage K, Lewis V, Kelly M, Blazeby JM, Kinnersley P, Edwards A. Systematic review and meta‐analysis of audio‐visual information aids for informed consent for invasive healthcare procedures in clinical practice. Patient Educ Couns. 2014 Jan;94(1):20‐32. 3. Nehme J, El‐Khani U, Chow A et al. The use of multimedia consent programs for surgical procedures: a systematic review. Surg Innov 2013; 20: 13–23.