INFORMED CONSENT

Cataract patients who took a seven-chapter interactive tutorial on the procedure were significantly better informed than controls educated with traditional methods, and the effect was especially pronounced in elderly patients, Christine Wollinger MD, of the Vienna Institute for Research in Ocular Surgery (VIROS), at Hanusch Hospital, Vienna, Austria, told the XXIX Congress of the ESCRS.

The system proved easy to use even for computer illiterate patients, and helped identify topics patients didn’t understand well, making face-to-face discussions more efficient and effective. “By law, the duty to inform a patient has to be carried out face-to-face between the patient and physician. In practice however, printed forms are simply handed to the patient and only a brief discussion is performed, so the informed consent is often insufficient to satisfy the patient’s requirement for information. It is also legally questionable,†Dr Wollinger said.

Interactive program

To address these shortcomings, Oliver Findl MD, MBA together with the company Eyeland developed a novel interactive program called CatInfo. It provides audio information via a headset and visually on a touch-screen monitor. The program leads the patient through what a cataract is, symptoms, treatment options, pre-assessment visit, day of surgery, risks and complications, and post-op treatment.

Patients can learn at their own pace. At the end of each chapter, patients are asked if they would like to repeat, discuss the contents later or move on. Patient feedback is recorded and printed out. It serves as a guideline for patient counselling and the patient-surgeon interview. It also provides legal documentation of the patient’s understanding and the informed consent process.

Dr Wollinger and colleagues tested the program in a randomised, controlled, patient and observer-masked study involving 90 patients. Thirty control patients were shown a five-minute sham program about the hospital that included no information on cataracts. Sixty study patients were given the interactive program lasting about 15 minutes. All patients then had a masked face-to-face discussion with the surgeon. Afterward, they were evaluated on their understanding with a multiple choice questionnaire. The 23-item questionnaire was developed based on focus groups of patients and ophthalmologists not involved in the study.

The study and control groups were closely matched demographically, and had similar computer experience, with about 70 per cent rarely or never using them, and about one-quarter using computers weekly or daily.

The study group scored significantly higher on the questionnaire, with a mean score of about 15 compared with about 12 for controls (p<0.05). Plotted against patient age, older study group patients scored as much as six points higher on average than similarly aged control subjects. Younger patients did only slightly better.

In addition to better informing patients about cataracts, the program made more-productive use of patient waiting-room time, and allowed surgeons to focus on their questions in face-to-face interviews.

“It also provides legal documentation of informed consent,†Dr Wollinger said.

The group plans to roll out the system for daily use in clinic, build add-ons for co-morbidities such as myopia, diabetes and pseudoexfoliation, and translate the package into other languages.

contact Christine Wollinger – christinewollinger@hotmail.com