The effect of multimedia interventions on the informed consent process for cataract surgery in rural South India

CONTEXT The provision of ocular surgical interventions for poorer, less educated populations is increasing as a result of increased globalization and outreach. However, these populations still have trouble understanding surgical concepts and are not always fully informed decision makers. AIMS We aimed to test the effect that a multimedia addition to a traditional verbal informed consent would have on patient comprehension of relatively difficult cataract surgical concepts. SETTINGS AND DESIGN We conducted a randomized controlled trial with relatively uneducated patients reporting to a private surgical hospital in Chennai, India. 47 patients were placed into the intervention group and 50 patients were placed into the control group. MATERIALS AND METHODS The intervention group was presented with a scripted verbal informed consent as well as a 3-fold pamphlet and a presentation with a 3-dimensional model of the eye. The control group was only presented with a scripted verbal informed consent. The two groups were tested using an 11 item "True/False/I don't know" quiz directly before the informed consent, directly after the informed consent, and one-day postoperatively. STATISTICAL ANALYSIS USED Scores on the quiz were compared across groups and time-points using paired t-tests. RESULTS Patients in the both groups showed a significant improvement in scores between pre- and post-informed consent quizzes (P value on the order of 10(-6)) and the improvement in scores was significantly greater in the intervention group than the control group (P value on the order of 10(-16)). There was no significant difference observed in either group with regards to the change in scores between post-informed consent and post-operative quizzes. CONCLUSION Multimedia aids in addition to a standard informed consent process are effective in improving patient comprehension even for patients with low literacy and limited knowledge of surgical interventions.