Informed consent is a cornerstone of ethical medical practice. However, traditional methods can sometimes fall short of truly preparing patients for complex procedures, especially when forms and discussions are overly broad or generalized. A forward-thinking approach is to utilize video to support and optimize the informed consent process.
In an ASHRM podcast, Bruce Keplinger, founding member of Norris Keplinger Hicks and Welder and mediator for Jay Daugherty Mediation and Arbitration, and Dr. Ankur Patel, co-chair of the North American Neuromodulation Society Residents and Fellows, offered helpful information surrounding this approach and why it will ultimately raise the quality of care provided across multiple health care settings.
Updated Guidelines Benefit from a Multimedia Component
Current recommendations regarding informed consent often offer high-level guidance and list a variety of risks—such as bleeding, infection, or organ injury—without tailoring this information to specific procedures or specialties. Recognizing this gap, the American Society of Pain and Neuroscience has developed guidelines focused on creating a more precise and accessible consent process for interventional pain physicians and spine surgeons.
“The goal here was to determine effective and appropriate education and informed consent practices. The authors had determined about eight best practice categories and provided consensus-based recommendations,” states Dr. Patel. “They're a bit more specific and tailored to interventional pain physicians and spine surgeons. Different areas of specialties will have their own variations in terms of guidance. But, one of the big components we had discussed was the use of multimedia.”
Studies have looked at the incorporation of multimedia in the informed consent process and have found that videos help patients increase their understanding of the procedure and its entailed risk. This results in higher satisfaction rates, and a generally lower likelihood that the patient will engage in litigation with their physician in case of an unanticipated outcome. (See Abujarad F, Peduzzi P, Mun S, Carlson K, Edwards C, Dziura J, Brandt C, Alfano S, Chupp G
Comparing a Multimedia Digital Informed Consent Tool With Traditional Paper-Based Methods: Randomized Controlled Trial. JMIR Form Res; 2021;5(10):e20458.)
Another benefit to the physician is that the video informed consent can ensure all the required information is presented to the patient, removing the risk that some information was incorrect or omitted. “This allows for patients to be really educated regarding the risks, benefits, and alternatives prior to them consenting for the procedure,” adds Dr. Patel.
Video Informed Consent: A Game-Changer in Risk Management
As a seasoned attorney who has spent four decades defending physicians and hospitals, Keplinger believes video in the informed consent process is a complete game-changer. He explains that a written consent form is technically “proof” of informed consent, but at best only part of the process. This becomes especially crucial when considering patients may only remember 25% of the risks and complications being explained to them. (See Langewitz W, Ackermann S, et al. Improving patient recall of information: Harnessing the power of structure. Patient Education and Counseling, 2015;98(6): 716-721. Doi: https://doi.org/10.1016/j.pec.2015.02.003.)
“You need to prove that the physician gave sufficient information for the patient to understand, and there can be a lot of reasons the patient didn't understand. They're nervous, they have language issues, they have capacity issues, there are cultural differences. There are lots of reasons why just putting a paper in front of somebody and having them sign it is not the end of the discussion,” he cautions. “Alternatively, the informed consent video is complete, it's consistent, it's tailored to the procedure.”
Keplinger projects that multimedia informed consent will continue to gain traction. However, he suggests that the best model going forward is a mutual decision-making standard—rather than the current dichotomy of some informed consent processes being physician-based and others being patient-based.
“That's what this video informed consent does. It gives a complete and consistent explanation of the current science on the risks, benefits, and alternatives, and still gives a patient with unique questions the opportunity to weigh in. Perhaps they're diabetic and that raises a special issue in a particular case. They can and should speak with their physician one-on-one about that particular unique aspect.”
Listen to the full discussion in ASHRM's podcast on Video Informed Consent.