We read with great interest this recent commentary by Masood et al. on informed consent. In their randomized study they concluded that adding written information about their surgical procedure did not improve the patients’ understanding compared with standard verbal consent. We also feel that the consenting process is far from adequate, and patient retention of information about their operative procedure and associated risks and complications is poor. This is particularly relevant in complex urological procedures where the patients’ understanding is paramount for the consent process to be valid. In our laparoscopic unit we have found that the use of a modified consenting process, with the addition of a video, has been beneficial to our patients . This is in addition to standard verbal consent and the provision of an information leaflet. The edited video, shown to patients on their admission to hospital, highlights parts of the surgery patients might find difficult to understand, e.g. incisions, insertion of ports, creating pneumoperitoneum, and short excerpts of relevant dissection. The relevant complications are discussed during the video and information about postoperative care given at the end. In this pilot study involving 43 patients undergoing predominantly upper urinary tract laparoscopy, 95% of those who watched the video found it extremely helpful to their understanding of the procedure; 81%t felt a video should be a mandatory part of the consent process. Interestingly, 15% did not read the leaflet provided and 8% said they could not understand the information provided within the leaflet.
Decision aids such as written information, audio-visual presentations and videos are useful adjuncts to the consenting process and a recent Cochrane review suggested that their provision improves knowledge and realistic expectations of the benefits and harms of options . The review also concluded there was no firm evidence to suggest that they increase anxiety. Within the NHS the commonest decision aids used are patient information leaflets. However, their role might be limited, as differences in age and socio-economic class require different levels of information. We think that video-assisted consenting has been a useful adjunct to the informed consent process. We have since adopted a similar approach to other laparoscopic, and now robotic surgery. Endoscopy and laparoscopy allow video footage to be easily obtained for operator appraisal, but can also be used for patient education. Technology is advancing at a furious pace and we should embrace all available resources to augment the consenting process.