VIVID: Video-supported consent for a Visually-aided, Informed Decision
Project Lead: Dr Ghali Salahia, Interventional Radiology Registrar
Participants: Dr Richard White, Consultant Interventional Radiologist,Dr Nimit Goyal, Consultant Interventional Radiologist, Robyn Davies, Cardiff and Vale University Health Board and Aneurin Bevan University Health Board
Industry partner: Prof David Wald, Explain my Procedure
Image-guided interventions may be difficult for patients to conceptualise, resulting in incomplete understanding when giving consent to such procedures. Time constraints, language barriers, and lack of physical IR clinic during the COVID-19 pandemic all present additional obstacles.
To introduce digital animations to support consent and to assess the effect of the animations on patient understanding.
Five animations in three languages (English, Welsh, and Arabic) were developed with patient and clinician involvement.
The procedures included peripheral angioplasty, endovascular abdominal aortic aneurysm repair, uterine fibroid embolisation, cerebral angiography, and fistuloplasty.
A pilot quality improvement study was done for patients undergoing peripheral angioplasty animation. Reported understanding of the reason for the procedure, its benefits, risks, and alternative treatments was assessed in 20 consecutive patients before introduction of the animations into practice (no animation group) and in 12 consecutive patients after their introduction (animation group). Patient understanding in the two groups was compared.
The project was aimed to empower patients by giving them freedom to watch the animation as many times as they want, from home, in a language that they can choose, with the opportunity to reflect with friends and family. It did not replace doctor/patient interaction but gave them an opportunity to think about their procedure in advance and to prepare questions.
The proportion of patients who completely understood the procedure and its benefits, risks, and alternatives were 55%, 65%, 15% and 10% respectively in the “no animation” group, and 83%, 83%, 67% and 67% in the “animation” group (p=0.1, 0.2, <0.05, and <0.05 respectively for each comparison).
Use of multi-language animations explaining angiography and angioplasty is feasible, was associated with improvement in patient understanding before the procedure, and assisted in overcoming obstacles imposed by the current COVID pandemic.
The project was an example of prudent healthcare. It empowered patients, made the most effective use of skills and technology, focused on common medical problems, and reduced variation in the quality of consent by using evidence based information.