The Impact of Artistic Representation on Patient Consent and Autonomy
Alberta Jeanne N.
Eurasian Experiment Journal of Scientific and Applied Research, 2024; 6(2)
Open Access
Abstract
Informed consent is fundamental to respecting patient autonomy in healthcare, ensuring that patients make voluntary, well-informed decisions about their treatment. However, consent processes can be hindered by communication barriers, time constraints, and differences in understanding complex medical information. Artistic representations in healthcare ranging from visual arts and music to theater—have emerged as potential tools to enhance patient comprehension and emotional engagement with medical procedures. This paper examines how various forms of art in healthcare environments may influence patient consent and autonomy. It considers the psychological, communicative, and therapeutic impacts of art, proposing that art can support consent by fostering deeper understanding and empathy between patients and healthcare providers. Four theoretical frameworks psychological impact, communicative theory, therapeutic influence, and autonomy in healthcare are analyzed to assess the efficacy of artistic representations in supporting patient-centered consent. By synthesizing empirical studies on artistic strategies in clinical settings, this article highlights the importance of interdisciplinary approaches to patient autonomy and explores the ethical implications of integrating art into consent processes.

Impact of Informative Videos on Proxy Consent by Parents for Pediatric Surgery: A Randomized Controlled Trial
Original Article
Shreyas Dudhani, Bindey Kumar, Amit Kumar Sinha, Amit Kumar, Rashi Rashi, Gaurav Shandilya
Journal of Indian Association of Pediatric Surgeons, November–December 2024; 29(6) pp 573-578
Abstract
Background
Consent is never truly exercised in children as parents act as their proxy and often do not understand the advantages, disadvantages, risks, and benefits of the procedure. Their high anxiety state is mirrored in the child, leading to slower recovery. Hence, this study was designed to understand if an intervention can impact the effect of consent on parents’ anxiety, satisfaction, and knowledge.
Methodology
A two-arm, parallel design, randomized controlled trial was conducted from March 2020 to March 2022 to analyze the effect of an educational video in comparison to an informational leaflet in parents giving proxy consents for various listed pediatric surgical procedures.
Results
Parents in the video group had a higher mean knowledge score (6.97 vs. 6.77, P = 0.40), comparable satisfaction scores (27.45 vs. 27.58, P = 0.88), and statistically insignificant difference between anxiety scores. We noted highest score of satisfaction (28.5/40) in the parents educated up to High School level or less. Knowledge scores were lowest in pelvic-ureteric junction obstruction (5.1/10) patients.
Conclusions
Our study done over a period of 2 years included a variety of diagnoses, and the videos and information leaflets were self-designed. It showed comparable anxiety, knowledge, or satisfaction in parents. Studies with more participants would be needed to take this research forward.

Comprehensive consent in urology using decision aids, leaflets, videos and newer technologies: empowering patient choice and shared decision-making
Review article
Carlotta Nedbal, Nithesh Naik, Niall Davis, Sanjeev Madaan, Theodoros Tokas, Giovanni Cacciamani, Eugenio Ventimiglia, Robert M. Geraghty, Dmitry Enikeev, Bhaskar K. Somani
Therapeutic Advances in Urology, 23 November 2024
Open access
Abstract
In this paper, we explore the usage of decision aids, patient information leaflets (PILs), videos, social media and modern technology to empower patients and enable shared decision-making (SDM). It explores the role of enhanced consent processes in urology. A re-evaluation of the conventional consent process is required towards more patient-centred care and SDM, which prioritises patient education and understanding of their medical conditions and treatment pathways. The use of decision aids, such as multimedia resources and PILs, is crucial in enhancing patients’ understanding, level of satisfaction, quality of life and healthcare utilisation. New tools are opening exciting possibilities for patient education and information distribution, such as Chat Generative Pre-Trained Transformer (ChatGPT). The effectiveness of ChatGPT in comparison to well-established PILs is still up for debate, despite the fact that it makes information easily accessible. Improving patients’ involvement, understanding and engagement in SDM procedures relies heavily on decision aids, PILs and current technological integration. Patients and healthcare practitioners should work together in accordance with the principles of SDM, which include considering patients’ values, backgrounds, priorities and preferences when making treatment decisions. The emphasis on patient-centred care has prompted a re-evaluation of traditional consent processes in urology, with more emphasis on the shared decision-making process. Several informative aids are currently available as reported in the literature, ranging from 3D models, multimedia presentations and virtual reality (VR) devices. While the costs of these tools might be substantial, the advantages of adopting such informative resources are unmistakable. Social media and platforms such as patient–physician blogs are increasingly popular sources of medical information. Urologists should embrace these platforms to enhance patient engagement and the quality of information provided. Despite recent progress, there remains significant room for improvement in patient education and engagement which is achievable via concerted efforts of a wider medical community.

Short-Form Video Informed Consent Compared With Written Consent for Adolescents and Young Adults: Randomized Experiment
Aliyyat Afolabi, Elaine Cheung, Joanne Chen Lyu, Pamela M Ling
JMIR Formative Research, 22 November 2024
Abstract
Background
Adolescents and young adults have the highest prevalence of e-cigarette use (“vaping”), but they are difficult to enroll in health research studies. Previous studies have found that video consent can improve comprehension and make informed consent procedures more accessible, but the videos in previous studies are much longer than videos on contemporary social media platforms that are popular among young people.
Objective
This study aimed to examine the effectiveness of a short-form (90-second) video consent compared with a standard written consent for a vaping cessation study for adolescents and young adults.
Methods
We conducted a web-based experiment with 435 adolescents and young adults (aged 13-24 years) recruited by a web-based survey research provider. Each participant was randomly assigned to view either a short-form video consent or a written consent form describing a behavioral study of a social media–based vaping cessation program. Participants completed a postexposure survey measuring three outcomes: (1) comprehension of the consent information, (2) satisfaction with the consent process, and (3) willingness to participate in the described study. Independent sample 2-tailed t tests and chi-square tests were conducted to compare the outcomes between the 2 groups.
Results
In total, 435 cases comprised the final analytic sample (video: n=215, 49.4%; written: n=220, 50.6%). There was no significant difference in characteristics between the 2 groups (all P>.05). Participants who watched the short-form video completed the consent review and postconsent survey process in less time (average 4.5 minutes) than those in the written consent group (5.1 minutes). A total of 83.2% (179/215) of the participants in the video consent condition reported satisfaction with the overall consent process compared with 76.3% (168/220) in the written consent condition (P=.047). There was no difference in the ability to complete consent unassisted and satisfaction with the amount of time between study conditions. There was no difference in the composite measure of overall comprehension, although in individual measures, participants who watched the short-form video consent performed better in 4 measures of comprehension about risk, privacy, and procedures, while participants who read the written document consent had better comprehension of 2 measures of study procedures. There was no difference between the groups in willingness to participate in the described study.
Conclusions
Short-form informed consent videos had similar comprehension and satisfaction with the consent procedure among adolescents and young adults. Short-form informed consent videos may be a feasible and acceptable alternative to the standard written consent process, although video and written consent forms have different strengths with respect to comprehension. Because they match how young people consume media, short-form videos may be particularly well suited for adolescents and young adults participating in research.

Virtual reality for patient informed consent in skull base tumors and intracranial vascular pathologies: A pilot study
Research
Emilia Westarp, Attill Saemann, Marek Zelechovski, Balazs Faludi, Philippe Cattin, Jehuda Soleman, Raphael Guzman
Acta Neurochirurgica, 15 November 2024
Open Access
Abstract
Purpose
With the growing demand for shared decision-making and patient-centered care, optimal informed consent (IC) has gained relevance. Virtual reality (VR) has seen significant technological advancements, and its medical applications currently include surgical planning and medical education. This pilot study investigates the feasibility of VR-enhanced informed consent (VR-IC) in neurosurgery to improve preoperative IC and patient satisfaction.
Methods
We included patients aged 18 to 75 years who were scheduled for skull base meningioma or brain aneurysm surgery between May and December 2023. Exclusion criteria were visual/auditory impairments and severe cognitive/psychiatric disorders. Patients received standard IC followed by VR-IC using patient-specific VR models of their pathology. After an initial demonstration by the surgeon, the patients used the VR station independently. A questionnaire with 18 questions on a 5-point Likert scale assessed the subjective impression of VR-IC.
Results
Ten patients participated in the study, with six (60%) undergoing aneurysm clipping and four (40%) undergoing skull base meningioma resection. The mean age of the participants was 58 years (± 15, range 27 to 75 years), with four female patients (40%). Patients overall rated the VR-informed consent (VR-IC) positively with a mean of 4.22 (± 0.84). There was a better understanding of their pathology (mean 4.30 ± 0.92) and the planned procedure (mean 3.95 ± 1.04). Trust in the surgeon was rated with a mean of 3.47 (± 0.94). Only minimal side effects from the VR experience including dizziness or discomfort were noted (mean 4.60 ± 0.22). None of the participants dropped out of the study.
Conclusion
VR-enhanced informed consent is feasible and improves patient understanding and satisfaction without significant side effects. These findings will guide the planning of a randomized controlled trial to validate the benefits of VR-IC in neurosurgery further.

A Randomized Controlled Trial of Video-Assisted Electronic Consent vs. Standard Consent for Percutaneous Kidney Biopsy (eConsent Bx)
Pedro Henrique Franca Gois, Vera Y. Miao, Rebecca Saunderson, Marina Wainstein, Kylie-Ann Mallitt, Shaun Patrick Chandler, Belinda Elford, Rebecca Hudson, Julia Jefferis, Helen Healy, Ann Bonner,
Journal of the American Society of Nephrology, October 2024
Abstract
Background
Video-assisted electronic consent (eConsent) enhances understanding, reduces anxiety, and boosts satisfaction in medical procedures. Yet, its impact on percutaneous kidney biopsies (PKB) remains unexplored. We aimed to assess patient-reported benefits of eConsent versus conventional consent for PKB.
Methods
In a single-center, open-label, RCT, consecutive patients undergoing PKB were randomized (1:1) to either video-assisted eConsent (intervention) or conventional consent (control). The intervention group accessed an online platform featuring an 8-minute explanatory animation before providing eConsent, while the control group was consented by clinicians and signed a paper form. The primary outcome was questionnaire-based patient comprehension, with secondary outcomes including patient-reported experience (KidneyPREM), anxiety, and satisfaction with consent.
Results
Median participant age was 52 years (IQR [34-65]), 30.7% had ≤ year 12 education and 69.3% post-secondary qualifications. Baseline characteristics were similar between groups. PKB comprehension was significantly higher in the intervention group compared to control (3 more questions correct/9; p<0.001), regardless of education level. Moreover, the intervention group demonstrated better understanding of critical information related to pre- and post-PKB care and when to seek medical attention for complications. There were no statistically significant differences in KidneyPREM, anxiety, or satisfaction between groups.
Conclusion
Video-assisted eConsent enhances PKB comprehension without affecting KidneyPREM, anxiety or satisfaction. These benefits extend to patients with lower education levels. Its implementation could standardize and streamline consent processes in PKB, with potential application in other nephrology domains.

Understanding and processing informed consent during data-intensive health research in sub-Saharan Africa: challenges and opportunities from a multilingual perspective
Research article
Lillian Omutoko, George Rugare Chingarande, Marietjie Botes, Farayi Moyana, Shenuka Singh, Walter Jaoko, Esperança Sevene, Tiwonge K Mtande, Ama Kyerewaa Edwin, Limbanazo Matandika, Theresa Burgess, Keymanthri Moodley
Research Ethics, 26 September 2024
Open access
Abstract
Africa has a colonial past that renders it a linguistic melting pot, where language is not only important for communication but is inextricably related to cultural identity. In Africa, there are over 2000 languages that are still being used and spoken. Language diversity coupled with cultural diversity may affect the process of obtaining informed consent in data-intensive research. We explore some of the challenges and opportunities of multilingualism in handling informed consent in the context of data-intensive research. In multilingual contexts, as in most African countries, language is exceptionally central, and translation has potential cultural, social, historical, functional and scientific importance. However, it is recognised that terminological and translation activities may not always be cost-effective or feasible. We consider alternative mechanisms of harmonisation of data-related terminology and concepts in multilingual contexts, such as iconography, graphic elicitation and other multimedia formats of information sharing. The inclusion of visual or multimedia explanations in informed consent forms can improve comprehension, enhance information transfer and learning, reduce potential vulnerabilities associated with low literacy levels or the inability to interpret technical language associated with data-intensive research, build trust with participants and their communities, and promote autonomy of potential participants. We recognise that the inclusion of visual or multimedia content to facilitate information transfer is only one component of the informed consent process for data-intensive research. Research ethics committees (RECs) should be mindful of other key considerations and challenges of informed consent for data-intensive research in sub-Saharan Africa (SSA), and to explore whether these alternative forms of consent are ethical and effective in multilingual contexts.

Infrastructuring Readability: Framing and Overflowing in Writing Assistant Software for Biomedical Research Informed Consent Forms
Research article
Loïc Riom, Solène Gouilhers, Claudine Burton-Jeangros
Science, Technology, & Human Values, 8 October 2024
Open access
Abstract
This article analyzes the development process of a software solution designed to assist researchers in writing biomedical research–informed consent forms. Funded by a Swiss ethics committee, the purpose of the software is to enhance the readability of such documents to improve biomedical research participants’ understanding of the information disclosed therein and to reduce the editing work of research ethics committees. Drawing on an embedded ethnographic research, we show how concerns that emerge in ethics reviews shape ethics committee IT infrastructure and how, in turn, this infrastructure contributes to redefining research ethics. We demonstrate that while the software reinforces the biomedical framing of research ethics, it also generates unexpected overflows. By forming new collectives, this infrastructuring process furthers expertise on informed consent forms while giving rise to new areas of inquiry and redefining the issue of readability in biomedical research. Thus, we provide insights into the complex entanglements between research ethic, computer programs, and writing practices. We conclude by reflecting on the role played by our research team during the software’s development and outline proposals on how ethnographic methods can contribute to make research ethics review accountable.

Electronic Surgical Consent Delivery Via Patient Portal to Improve Perioperative Efficiency
Original Investigation
Karen Trang, Hannah C. Decker, Andrew Gonzalez, Logan Pierce, Amy M. Shui, Genevieve B. Melton-Meaux, Elizabeth C. Wick
JAMA Surgery, 11 September 2024
Abstract
Importance
Many health systems use electronic consent (eConsent) for surgery, but few have used surgical consent functionality in the patient portal (PP). Incorporating the PP into the consent process could potentially improve efficiency by letting patients independently review and sign their eConsent before the day of surgery.
Objective
To evaluate the association of eConsent delivery via the PP with operational efficiency and patient engagement.
Design, Setting, and Participants
This mixed-methods study consisted of a retrospective quantitative analysis (February 8 to August 8, 2023) and a qualitative analysis of semistructured patient interviews (December 1, 2023, to January 31, 2024) of adult surgical patients in a health system that implemented surgical eConsent. Statistical analysis was performed between September 1, 2023, and June 6, 2024.
Main Outcomes and Measures
Patient demographics, efficiency metrics (first-start case delays), and PP access logs were analyzed from electronic health records. Qualitative outcomes included thematic analysis from semistructured patient interviews.
Results
In the PP-eligible cohort of 7672 unique patients, 8478 surgical eConsents were generated (median [IQR] age, 58 [43-70] years; 4611 [54.4%] women), of which 5318 (62.7%) were signed on hospital iPads and 3160 (37.3%) through the PP. For all adult patients who signed an eConsent using the PP, patients waited a median (IQR) of 105 (17-528) minutes to view their eConsent after it was electronically pushed to their PP. eConsents signed on the same day of surgery were associated with more first-start delays (odds ratio, 1.59; 95% CI, 1.37-1.83; P < .001). Themes that emerged from patient interviews included having a favorable experience with the PP, openness to eConsent, skimming the consent form, and the importance of the discussion with the surgeon.
Conclusions and Relevance
These findings suggest that eConsent incorporating PP functionality may reduce surgical delays and staff burden by allowing patients to review and sign before the day of surgery. Most patients spent minimal time engaging with their consent form, emphasizing the importance of surgeon-patient trust and an informed consent discussion. Additional studies are needed to understand patient perceptions of eConsent, PP, and barriers to increased uptake.

Systematic Review and Meta-Analysis of Interactive multimedia Interventions used in the Informed Consent Process
Joshua Michael Clements, Jake Simon Clements, Mike Clarke, Stephen Kirk
British Journal of Surgery, 9 September 2024
Abstract
Aim
The use of digital technology to improve the informed consent process has increased over the past decade. A wide range of multimedia modalities are now available. This review aimed to assess the impact of interactive multimedia interventions on the informed consent process.
Methods
This was a subgroup analysis of a larger systematic review and meta-analysis conducted in accordance with a predefined protocol registered on PROSPERO (CRD42023380406). Five databases were searched using pre-defined search criterion in December 2022 for randomised trials of interactive multimedia interventions designed to improve the informed consent process. Adults >18 years undergoing invasive interventions with the capacity to consent were included. The Cochrane Risk of Bias (RoB) tool was used to assess study quality. Standardised mean difference for continuous variables and risk ratios for dichotomous variables were used to assess effect. Meta-analyses were performed in RevMan5.
Results
21 studies (22 interventions arms) with 2090 participants were included. All studies involved patients undergoing informed consent in an elective hospital setting for various surgical, cardiological and radiological procedures. Statistically significant improvement in immediate (SMD 0.40, 95% CI 0.18 to 0.62, I2=55%) and short-term knowledge (SMD 0.47, 95% CI 0.16 to 0.79, I2=45%) were demonstrated. No statistically significant differences were found for long term knowledge, generalised anxiety, satisfaction with the consent process or length of consultation.
Conclusions
Interactive multimedia interventions improve immediate and short-term knowledge in patients undergoing invasive interventions and could be considered as an adjunct to enhance patient knowledge during the informed consent process.