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Coronary artery disease
Original research
Animation-supported consent for urgent angiography and angioplasty: a service improvement initiative
  1. David S Wald1,2,
  2. Oliver Casey-Gillman2,
  3. Katrina Comer2,
  4. Josephine Sarah Mansell3,
  5. Zhi H Teoh4,
  6. Kyriacos Mouyis5,
  7. Matthew Kelham6,
  8. Fiona Chan7,
  9. Selda Ahmet8,
  10. Max Sayers9,
  11. Vincent McCaughan10,
  12. Nito Polenio11
  1. 1Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
  2. 2St Bartholomew’s Hospital, Barts Heart Centre, London, UK
  3. 3Department of Cardiology, Barts Health NHS Trust, London, UK
  4. 4Department of Cardiology, Newham University Hospital, London, UK
  5. 5Department of Cardiology, Royal London Hospital, London, UK
  6. 6Department of Cardiology, North Middlesex University Hospital, London, UK
  7. 7Department of Cardiology, Whittington Hospital, London, UK
  8. 8Department of Cardiology, Whipps Cross University Hospital, London, UK
  9. 9Department of Cardiology, Homerton University Hospital, London, UK
  10. 10Department of Cardiology, King George Hospital, Ilford, UK
  11. 11Department of Cardiology, University College Hospital, London, UK
  1. Correspondence to Professor David S Wald, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK; d.s.wald{at}qmul.ac.uk

Abstract

Objective Patient understanding of angiography and angioplasty is often incomplete at the time of consent. Language barriers and time constraints are significant obstacles, particularly in the urgent setting. We introduced digital animations to support consent and assessed the effect on patient understanding.

Methods Multi-language animations explaining angiography and angioplasty (www.explainmyprocedure.com/heart) were introduced at nine district hospitals for patients with acute coronary syndrome before urgent transfer to a cardiac centre for their procedure. Reported understanding of the reason for transfer, the procedure, its benefits and risks in 100 consecutive patients were recorded before introduction of the animations into practice (no animation group) and in 100 consecutive patients after their introduction (animation group). Patient understanding in the two groups was compared.

Results Following introduction, 83/100 patients reported they had watched the animation before inter-hospital transfer (3 declined and 14 were overlooked). The proportions of patients who understood the reason for transfer, the procedure, its benefits and risks in the no animation group were 58%, 38%, 25% and 7% and in the animation group, 85%, 81%, 73% and 61%, respectively. The relative improvement (ratio of proportions) was 1.5 (95% CI 1.2 to 1.8), 2.1 (1.6 to 2.8), 2.9 (2.0 to 4.2) and 8.7 (4.2 to 18.1), respectively (p<0.001 for all comparisons).

Conclusion Use of animations explaining angiography and angioplasty is feasible before urgent inter-hospital transfer and was associated with substantial improvement in reported understanding of the procedure, its risks and its benefits. The approach is not limited to cardiology and has the potential to be applied to all specialties in medicine.

  • consent
  • animation
  • acute coronary syndrome
  • angiography
  • angioplasty
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/heartjnl-2019-316227

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    Footnotes

    • Twitter @NitoPolenio

    • Correction notice This article has been corrected since it was first published. Author name Howie Teo has been updated to Zhi H Teoh.

    • Contributors DSW conceived the project and wrote the first draft of the manuscript. OC-G and KC collected the data. All authors contributed to the design and implementation of the study, analysis and review of the paper and approved it for publication.

    • Disclaimer The Barts Charity funded the videobooks and had no role in the project design, conduct, collection of data, analysis, interpretation or decision to publish the paper.

    • Competing interests DSW set up and leads Explain My Procedure, a platform for animations explaining medical procedures to patients to support consent. Users can request access online (https://explainmyprocedure.com/).

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available. All data included in the paper.

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