The Role of Incorporating Video Aids Into Informed Consent for Hysterectomy

INTRODUCTION: The informed consent process for a hysterectomy is a physician-led discussion regarding the surgical removal of the uterus. Audiovisual aids have been shown to improve patient satisfaction, preparedness, and long-term knowledge retention during the informed consent process. There are a limited number of prospective studies assessing presurgical preparedness in field of gynecology; further, most of these studies limit enrollment to English-speaking patients. OBJECTIVE: Our study explores whether augmenting the consent process with the addition of a video aid for a hysterectomy can enhance patients’ comprehension and postoperative satisfaction in a border population that predominantly speaks Spanish. METHODS: A prospective cohort study was performed at TTUHSC-El Paso Ob-Gyn clinics, including patients at least 18 years of age undergoing hysterectomy for benign gynecologic indications. Both English and Spanish-speaking patients were recruited. The experimental arm viewed the video aid in their language of choice (English or Spanish) in addition to receiving standard physician counseling for consent of hysterectomy. The control arm received standard physician counseling only. The ICQ-20 survey was used to evaluate patients’ comprehension at their pre- and postoperative visits. Longitudinal data analyses were performed using logistic regression. Generalized estimating equations (GEE) were used to account for the repeated measurement (preoperative and postoperative) of the outcomes. Odds ratios (OR) for the intervention effect (video vs. control) and 95% confidence intervals (CI) were calculated. Intervention-by-time interaction was not detected for our three patient knowledge outcomes. RESULTS: 55 subjects (27 in the video arm, 28 in the control arm) contributed a total of 108 records for longitudinal analysis. The mean age (SD) of the subjects were 46.1 (9.4) and 45.6 (5.7) years in the video and control arms, respectively. Majority of the subjects were Hispanic (92.6% in the video arm, 85.7% in the control arm). For the binary outcome of knowing enough to explain the procedure (Yes vs. No), the percentage answering Yes in the video arm was 100% and 88.9% during the preoperative and postoperative visits, respectively, while this percentage in the control arm was 92.9% and 84.6% during the preoperative and postoperative visits, respectively. The video aid (vs. control) did not have an impact on the following three binary knowledge outcomes (Yes vs. No) in the GEE logistic regression analyses: Subjects knew enough about the procedure that they could explain it to another person how it would occur (OR=1.56, 95% CI: 0.32–7.51, p=0.58), having been informed of the common risk of need for a urinary catheter after the procedure (OR=2.16, 95% CI: 0.84–5.60, p=0.11), and having knowledge of the success rate of the procedure (OR=0.52, 95% CI: 0.20–1.41, p=0.2). CONCLUSIONS: The level of patient comprehension was high (>89%) for two of our outcomes (ability to explain the procedure, and awareness of possible consequences) preoperatively in both the video and control arms. Postoperative, the two arms had similar knowledge levels for these two outcomes. After accounting for repeated measurements, no effect of the video aid was detected.