Video Consent for Upper Endoscopy and Colonoscopy Improves Patient Comprehension in a Safety-net, Multi-lingual Population

Abstract

The challenges of consenting for procedures are well documented and are compounded when patients have limited English proficiency (LEP). Standardized video consent has been studied, but research in gastroenterology is limited. We created educational videos in English and Spanish covering the elements of traditional consent for colonoscopy and upper endoscopy. All participants underwent traditional verbal consent and a subset viewed the language and procedure specific video. Participants from a multilingual, safety-net hospital patient population were then given a questionnaire to assess their comprehension and satisfaction. Participants who watched the video had higher comprehension scores than those who received traditional verbal consent alone. This difference persisted when data was stratified by language and procedure, and when controlled for educational level and prior procedure. Video consent improves comprehension and satisfaction for endoscopy and may mitigate some of the challenges encountered when consenting patients with LEP.

Full text

Vol:.(1234567890)
Journal of Immigrant and Minority Health (2023) 25:350–356
https://doi.org/10.1007/s10903-022-01398-6
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ORIGINAL PAPER
Video Consent forUpper Endoscopy andColonoscopy Improves
Patient Comprehension inaSafety‑net, Multi‑lingual Population
ZoeLawrence1 · GabrielCastillo1· JaniceJang1· TimothyZaki4· DemetriosTzimas2· AlexandraGuttentag3·
AdamGoodman1· AndrewDikman1· ReneeWilliams1
Accepted: 15 August 2022 / Published online: 24 September 2022
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022
Abstract
The challenges of consenting for procedures are well documented and are compounded when patients have limited English
proficiency (LEP). Standardized video consent has been studied, but research in gastroenterology is limited. We created edu-
cational videos in English and Spanish covering the elements of traditional consent for colonoscopy and upper endoscopy. All
participants underwent traditional verbal consent and a subset viewed the language and procedure specific video. Participants
from a multilingual, safety-net hospital patient population were then given a questionnaire to assess their comprehension
and satisfaction. Participants who watched the video had higher comprehension scores than those who received traditional
verbal consent alone. This difference persisted when data was stratified by language and procedure, and when controlled
for educational level and prior procedure. Video consent improves comprehension and satisfaction for endoscopy and may
mitigate some of the challenges encountered when consenting patients with LEP.
Keywords Limited English proficiency· Gastroenterology· Endoscopy· Consent
Background
Informed consent involves a thorough understanding of the
planned procedure and its risks, benefits, and alternatives
[1]. On the day of the procedure, when patients are fasting
and anxiety levels are elevated, information presented during
verbal consent can often be overwhelming and difficult to
retain. Data on adult learning theory have shown low reten-
tion rates from lecture-style teaching for the adult learner
[2]. In patients with limited English Proficiency (LEP), the
challenges of verbal consent are even more pronounced
[3]. Individuals with LEP make up 9% of the United States
population, and this segment of the population has been
increasing steadily since the 1990s largely due to immigra-
tion [4]. In New York City, almost 25% of the population
has LEP [5]. Limited Health Literacy (LHL) is also highly
prevalent ranging from 19 to 61% for various medical con-
ditions [6]. This is particularly relevant to the healthcare
field, asindividuals with LEP and LHL are more likely to
be uninsured, less likely to seek medical care and to receive
high-quality care compared to their English-proficient (EP)
counterparts [7]. Despite these obstacles, healthcare provid-
ers still rely on traditional verbal consent for most medical
procedures.
Studies evaluating the use of videos during the informed
consent process for procedures such as cataract surgery,
knee arthroscopy, hysterectomies, cystoscopies, and spinal
surgery [8–12] demonstrate that the use of videos improves
patient comprehension relative to traditional verbal consent.
Patients who watch a video prior to consent consistently
score higher on knowledge-based questionnaires. Addition-
ally, enhancing traditional verbal consent with a video has
been shown to shorten the consent process [10]. This evi-
dence is consistent with principles of adult learning theory
in practice which posit that active construction is integral to
successful learning [2]. Most learners will develop a pref-
erence for a particular learning method such as auditory
* Zoe Lawrence
zoe.lawrence@nyulangone.org
1 Division ofGastroenterology, NYU Langone Health,
NewYork, NY10016, USA
2 Department ofGastroenterology, Northwell Health,
Huntington, NY11743, USA
3 NYU School ofGlobal Public Health, NewYork, NY10003,
USA
4 Department ofMedicine, The University ofTexas
Southwestern Medical Center, Dallas, TX75390, USA
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