Video as a Patient Teaching Tool

Abstract

Meeting the anesthesiologist is one of the surgical patient's highest priorities preoperatively [1], and several reports document that this interaction reduces patient anxiety [2-4]. High anxiety may be associated with poorer surgical outcome [5], whereas improved patient education is associated with increased patient satisfaction [6] and improved clinical outcome [7]. Video instruction may supplement conventional instruction techniques for general medical patients [8] and aid in obtaining informed consent [9]. No study has specifically evaluated an instructional video about anesthesia as a tool for educating surgical patients about their upcoming anesthetic and facilitating the anesthesiologist-patient relationship. The hypothesis of this study is that viewing an anesthesia preoperative video will improve patient knowledge and patient perception of the upcoming anesthetic and surgery compared to a standard preoperative interview without video instruction. Methods This study was approved by the institutional research review board with a waiver of informed consent. Over a 2-wk study period, patients presenting to the Preadmission Testing Area (PAT) of The North Carolina Baptist Hospital for an anesthesia preoperative visit were randomly assigned to one of two study groups: Group A patients viewed a 10-min video about anesthesia and surgery prior to seeing the anesthesiologist; Group B patients did not see the video before their preanesthetic interview. On concluding their PAT visit, all patients completed a questionnaire scoring both informational items and patient perceptions about anesthesia and the preanesthetic interview. Two more questions allowed the patient to identify the best and worst part of the PAT visit. The questionnaire is found in Appendix A. Table 4Table 4: Appendix A: Questionnaire Given to Patients After Preoperative EvaluationTo achieve a representative sample of our ambulatory surgical population, all adult patients presenting to the PAT during the 2-wk study period were included in the study. No stipulation was made to classify patients by age, level of education, prior knowledge or experience with anesthesia or surgery, or type of surgical procedure planned. The video specifically highlighted the hospital ambulatory surgery admission procedure: when to stop eating and drinking before surgery, what role the anesthesiologist plays in surgery and during recovery, who is involved in the anesthesia care team, and a description of risks and likely expectations. The anesthesia interview was conducted uniformly in all patients. The majority of patients were interviewed by one of two study authors (ACM or DDM), and in a minority of patients by an anesthesiology resident under the supervision of the study authors (ACM or DDM). The interview consisted of a standard anesthetic history and physical as well as a period of information dissemination and question answering. Information provided included the hospital ambulatory surgery admission procedures listed above. The anesthesia interviewer was initially blinded to the study group in all patients. In approximately 5 to 10 patients (2.8%-5.6%), the study group became apparent during the anesthesia interview; however, no deviation from the standard history, physical, or preoperative teaching occurred as a consequence of this discovery. These patients were not excluded from final analysis. The data were analyzed by a two-tailed Fisher's exact test or chi squared test as appropriate. Significant differences between groups were assumed when P < 0.05. Results We evaluated 178 patients in this study: 91 in Group A (47 males, 44 females), and 87 in Group B (41 males, and 46 females). In the video group, a significant number of patients knew the proper procedure to take if they did not feel well before outpatient surgery, compared to patients who did not see the video (98.9% versus 86.2%, P = 0.03). There were no other significant differences in the five remaining knowledge-based items Table 1. There were no significant differences between groups in patient perceptions about admission procedures, expectations in the recovery period, or general perceptions of "well being" about the upcoming surgery Table 2. There was a significant difference between groups when asked about the utility of video instruction: 84.6% of patients who viewed the video found it extremely helpful, whereas only 41.4% of patients not viewing the video thought a video would be helpful (P < 0.01).Table 1: Results of Knowledge-Based ItemsTable 2: Results of Patient Perceptions About Surgery and AnesthesiaAnalysis of the open-ended questions revealed significantly more complaints about the long wait in the preadmission testing clinic in the video group compared with the nonvideo group, P = 0.03 Table 3. There was a greater tendency for patients in the video group to comment positively on the knowledge gained during the preadmission testing visit than in the nonvideo group, although this difference did not reach statistical significance, P = 0.066 Table 3.Table 3: Results Detailing the Reported Best and Worst Parts of the Preadmission Testing VisitDiscussion If we require our patients to view an anesthesia video, then there must be some measurable gain from this exercise. Benefit may be measured as an increase in the amount of information retained, or more subtly, in a subjective improvement in perceptions about well-being. Our hypothesis was that viewing a video about anesthesia in the PAT would significantly improve patients' knowledge and perception of their upcoming surgery and anesthetic compared to a standard preoperative interview without video instruction. However, our data demonstrate little quantitative differences in factual knowledge, and no differences in perceived knowledge or well-being between groups. This lack of difference between groups occurred despite the fact that 85% of patients seeing the video rated it as a very helpful part of the PAT visit. What can we conclude from these data? There are two potential explanations: either our video offers nothing further over a conventional anesthesia interview, or our testing instrument is not sensitive enough to detect a difference. There are data to support the contention that the video adds to the preoperative visit; 85% of patients seeing the video thought that it was helpful, whereas only 41% of patients not seeing the video thought it would be of additional value. In other words, those who saw it, liked it. We can only assume, therefore, that the video was either entertaining or educational, or both. The data from Table 3 suggest an educational benefit. When asked what the best part of the PAT visit was, 43% of patients in Group A indicated it was the knowledge gained, whereas only 26% of patients in Group B responded this way. Although these data are not statistically significant (P = 0.066), there was a tendency in Group A patients to comment specifically on the information gained during the visit as compared to patients in Group B. In addition, a significantly larger number of patients in Group A complained of the long wait in PAT. These patients may have had a longer wait because of the video, yet this group overwhelmingly found the video helpful. Therefore, these data may suggest a benefit in the video group despite our other data showing little difference between groups. Our questionnaire highlighted three areas that deserve special comment. Approximately 12% of patients in each group could not identify the anesthesiologist as a physician. Less than 50% of our patients clearly understood when to stop eating and drinking before surgery. And, lastly, in our university hospital, in which nearly all patients are cared for using an anesthesia care team model, only 45% of patients realized that a nurse anesthetist or an anesthesia resident would be involved in their care. These numbers are unacceptable and highlight the need to improve our communication with our patients. In conclusion, we were unable to detect a significant difference between the groups in terms of knowledge retained, or perceptions about the upcoming surgery and anesthetic. Patients seeing the video rated it a very helpful component of PAT, even though a significant number of them complained about the long wait. Several of our patients had significant misinformation despite the preoperative interview, with or without the video. Based on the positive patient response to the video, we will continue video instruction as a component of the preoperative anesthetic visit.