Improving comprehension, recall and attention using multimedia-informed assent among pediatric oncology patients: A comparative randomized controlled trial
Psychosocial and Supportive Care: Research Article
Passara Wongthai, Apichat Photia, Chanchai Traivaree, Chalinee Monsereenusorn, Nawachai Lertvivatpong, Khemika Khemakanok Sudnawa, Piya Rujkijyanont
Pediatric Blood & Cancer, 25 May 2022
Abstract
Background
Assent should be obtained in all children involved in research in keeping with their level of maturity. Traditional assent forms contain too much information and are difficult to read. The study aimed to identify an effective tool to enhance children’s comprehension during the assent process and focused on those with cancer who are likely more engaged in research involving greater than minimal risk.
Methods
In all, 116 children with cancer were randomized to receive either a paper-based assent document or a multimedia-based assent document. Open-ended and multiple-choice questions were used to assess comprehension and recall. Time spent on the documents and children’s behavior during the assent process was recorded to determine their attention and satisfaction.
Results
Children randomized to a multimedia-based assent document achieved significant higher comprehension and recall assessment scores (p-values <.001). The high score achievement significantly correlated with the child’s age with adjusted odds ratio (OR) of 1.90 (p-value <.001; 95% confidence interval [CI]: 1.35–2.66) for comprehension assessment and 1.59 (p-value .001; 95% CI: 1.20–2.12) for recall assessment. Children randomized to a multimedia-based assent document had significant longer time spent on the document (p-value .001) with less numbers of inattention (p-value <.001) and expressed more signs of enjoyment during the assent process (p-values <.001).
Conclusion
Multimedia-based assent document successfully enhanced comprehension, recall, and attention with more satisfaction compared with a traditional paper-based document among children with cancer. This approach may be considered as an alternative format for children engaging in research involving greater than minimal risk.

Context, Prioritization, and Unexpectedness: Factors Influencing User Attitudes About Infographic and Comic Consent
Xengie Doan, Annika Selzer, Arianna Rossi, Wilhelmina Maria Botes, Gabriele Lenzini
WWW ’22 Companion, 25-29 April 2022; Lyon, France [Virtual Event]
Open Access
Abstract
Being asked to agree to data disclosure is a ubiquitous experience in digital services – yet it is rare to encounter a well-designed consent experience. Considering the momentum for a European data space where personal information easily flows across organizations, sectors, and nations, solving the thorny issue of “how to get consent right” cannot be postponed any further. In this paper, we describe the first findings from a study based on 24 semi-structured interviews investigating participants’ expectations and opinions toward a consent form redesigned as a comic and an infographic in a data-sharing scenario. We found that time, information prioritization, tone, and audience fit are crucial when individuals are invited to disclose their information and the infographic is a better fit in biomedical scenarios.

Effective Communication of Personalized Risks and Patient Preferences During Surgical Informed Consent Using Data Visualization: Qualitative Semistructured Interview Study With Patients After Surgery
Undina Gisladottir, Drashko Nakikj,  Rashi Jhunjhunwala, Jasmine Panton, Gabriel Brat, Nils Gehlenborg
JMIR Hum Factors, 1 April 2022; 9(2)
Abstract
Background
There is no consensus on which risks to communicate to a prospective surgical patient during informed consent or how. Complicating the process, patient preferences may diverge from clinical assumptions and are often not considered for discussion. Such discrepancies can lead to confusion and resentment, raising the potential for legal action. To overcome these issues, we propose a visual consent tool that incorporates patient preferences and communicates personalized risks to patients using data visualization. We used this platform to identify key effective visual elements to communicate personalized surgical risks.
Objective
Our main focus is to understand how to best communicate personalized risks using data visualization. To contextualize patient responses to the main question, we examine how patients perceive risks before surgery (research question 1), how suitably the visual consent tool is able to present personalized surgical risks (research question 2), how well our visualizations convey those personalized surgical risks (research question 3), and how the visual consent tool could improve the informed consent process and how it can be used (research question 4).
Methods
We designed a visual consent tool to meet the objectives of our study. To calculate and list personalized surgical risks, we used the American College of Surgeons risk calculator. We created multiple visualization mock-ups using visual elements previously determined to be well-received for risk communication. Semistructured interviews were conducted with patients after surgery, and each of the mock-ups was presented and evaluated independently and in the context of our visual consent tool design. The interviews were transcribed, and thematic analysis was performed to identify major themes. We also applied a quantitative approach to the analysis to assess the prevalence of different perceptions of the visualizations presented in our tool.
Results
In total, 20 patients were interviewed, with a median age of 59 (range 29-87) years. Thematic analysis revealed factors that influenced the perception of risk (the surgical procedure, the cognitive capacity of the patient, and the timing of consent; research question 1); factors that influenced the perceived value of risk visualizations (preference for rare event communication, preference for risk visualization, and usefulness of comparison with the average; research question 3); and perceived usefulness and use cases of the visual consent tool (research questions 2 and 4). Most importantly, we found that patients preferred the visual consent tool to current text-based documents and had no unified preferences for risk visualization. Furthermore, our findings suggest that patient concerns were not often represented in existing risk calculators.
Conclusions
We identified key elements that influence effective visual risk communication in the perioperative setting and pointed out the limitations of the existing calculators in addressing patient concerns. Patient preference is highly variable and should influence choices regarding risk presentation and visualization.