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Graphic narratives may improve patient comprehension, reduce anxiety before coronary angiography
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Supplementing standard informed consent with medical graphic narratives may more clearly articulate complex health information to patients, leading to greater comprehension and reduced anxiety before undergoing coronary angiography, according to a research report published in the Annals of Internal Medicine.
“Realizing the shortcomings and limitations of usual patient information and consent material in our daily work, Verena Stangl, MD, had the idea of illustrating central aspects of the patient informed consent to make the contained difficult and complex information more understandable for patients,” Anna Brand, MD, an interventional cardiologist at the Charité – Universitätsmedizin Berlin, told Healio Primary Care Today. “The aim was to illustrate all important aspects of the official legal patient informed consent in the comic book. Importantly, the comic supplements, but does not replace, the official information and consent form. We balance accessibility and accuracy by combining these consent methods.”
Researchers randomized patients who were hospitalized and undergoing coronary angiography between October 2016 and January 2018 to either the standard informed consent group (n = 61) or the comic informed consent group (n = 60). Standard care consisted of an official consent form and a conversation with a physician. The comic informed consent group received these standard procedures with the addition of the patient comic, which was filled with graphic illustrations of central informed consent aspects based on the official consent form.
The primary outcomes of the study were the comprehension of procedure-related information, which was assessed by a self-designed questionnaire, and periprocedural state anxiety, which was evaluated with the Spielberger State-Trait Anxiety Inventory (STAI) before and after the informed consent procedure.
Researchers found that patients in the comic group had higher scores than those in the standard group in procedural details, risks and behavioral measures after the procedure, demonstrating better comprehension.
Patients in the comic group also showed greater improvements in anxiety. Overall, the mean STAI score decreased in the comic group after the informed consent procedure, while it increased in the standard group (difference in change from baseline:–5.1 points; 95% CI, –7.32 to –2.94).
In addition, the mean STAI score for women decreased in the comic group by 3.6 points (95% CI, 1.35-5.81) but increased by 1.8 points in the standard group (95% CI, –0.53 to 4.06). For men, the mean STAI score decreased by 2.5 points in the comic group (95% CI, 0.22-4.73) and increased by 2.2 points in the standard group (95% CI, 0.01-4.31).
“After providing the first proof-of-concept data regarding the utility of comics in the informed consent procedure, we plan to investigate its possible beneficial effects in other standard procedures in cardiovascular medicine,” Brand said. “Patients with low literacy or elderly patients may especially benefit from this illustrated consent method.” – by Melissa J. Webb
Disclosures: The study was funded by the Friede Springer Herz Stiftung.