Comparing preoperative video education with face-to-face education by the anesthesiologist before informed consent for anesthesia: a pilot randomized controlled trial (Preprint)

Abstract

Traditionally, the fulfilment of legal obligations for preoperative education and informed consent prior to anesthesia predominantly relied on face-to-face interactions. However, considering the progress of contemporary technological advancements, alternative methods should be explored. We hypothesized that video education would result in non-inferior knowledge compared to face-to-face education by an anesthesiologist. This study aimed to assess the effect size of video education compared to face-to-face education and the feasibility of a future full randomized clinical trial (RCT).

To assess feasibility of a definitive trial in our hospital and to determine the effect size of video education on short-, intermediate-, and long-term retention of knowledge.

Reporting was in accordance with the Consolidated Standards of Reporting Trials for pilot and feasibility studies. In this four-arm pilot RCT, adult patients visiting the preoperative screening clinic of a tertiary medical center in the Netherlands were enrolled over a period of six months (April to September 2021). Participants were allocated using simple randomization (1:1:1:1) embedded in the trial software. The main outcome measures were the effect size of web-based video vs. face-to-face education as measured by the Rotterdam Anesthesia Knowledge Questionnaire (RAKQ) on days 0, 14, and 42 and loss to follow-up rates on days 14 and 42. The participants completed the questionnaire on day 0 while visiting the outpatient clinic and were sent links via email to complete online questionnaires on days 14 and 42.

The effect size of video versus face-to-face education on day 0 was large (Cohen’s D = 1.08), and moderate on day 14 (Cohen’s D = 0.47). The corresponding median [IQR] number of correct answers on the knowledge questionnaire on day 0 was higher after video education (26.0 [24.0 to 28.0]) than after the anesthesiologist (21.5 [20.0 to 25.0]). The recruitment rate was six participants per week. The loss to follow-up rates were, on average, 43.0% after 14 days and 61.7% after 42 days.

This pilot trial demonstrated a moderate-to-large effect size of video education versus face-to-face education on patients’ knowledge. Loss to follow-up rates were high, but with adjustments made to the follow-up process, this four-arm RCT design is feasible in our hospital.

ISRCTN, ISRCTN13174388. Registered 17 August 2022 - Retrospectively registered, https://www.isrctn.com/ISRCTN13174388.