Personalized surgical informed consent with stereoscopic visualization in neurosurgery—real benefit for the patient or unnecessary gimmick?

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Abstract

Background

Informed consent of the patient prior to surgical procedures is obligatory. A good and informative communication improves patients’ understanding and confidence, thus may strengthen the patient-doctor relationship. The aim of our study was to investigate the usefulness of additional stereoscopic visualization of patient-specific imaging during informed consent conversation.

Methods

Patients scheduled for a brain tumor surgery were screened for this study prospectively. The primary exclusion criteria were cognitive or visual impairments. The participants were randomized into two groups. The first group underwent a conventional surgical informed consent performed by a neurosurgeon including a demonstration of the individual MRI on a 2D computer screen. The second group received an additional stereoscopic visualization of the same imaging to explain the pathology more in-depth. The patients were then asked to fill in a questionnaire after each part. This questionnaire was designed to assess the potential information gained from the patients with details on the anatomical location of the tumor as well as the surgical procedure and possible complications. Patients’ subjective impression about the informed consent was assessed using a 5-point Likert scale.

Results

A total of 27 patients were included in this study. After additional stereoscopic visualization, no significant increase in patient understanding was found for either objective criteria or subjective assessment. Participants’ anxiety was not increased by stereoscopic visualization. Overall, patients perceived stereoscopic imaging as helpful from a subjective perspective. Confidence in the department was high in both groups.

Conclusion

Stereoscopic visualization of MRI images within informed consent conversation did not improve the objective understanding of the patients in our series. Although no objective anatomical knowledge gain was noted in this series, patients felt that the addition of stereoscopic visualization improved their overall understanding. It therefore potentially increases patient confidence in treatment decisions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00701-023-05512-x.

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Most cited references 37

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3D-printing techniques in a medical setting: a systematic literature review

Philip Tack, Jan Victor, Paul Gemmel … (2016)

Background Three-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes. Methods Three major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans. Results 227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure. Conclusion 3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D-printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost–effectiveness analysis. Electronic supplementary material The online version of this article (doi:10.1186/s12938-016-0236-4) contains supplementary material, which is available to authorized users.

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Interventions to improve patient comprehension in informed consent for medical and surgical procedures: a systematic review.

Yael Schenker, Alicia Fernández, Rebecca Sudore … (2011)

Patient understanding in clinical informed consent is often poor. Little is known about the effectiveness of interventions to improve comprehension or the extent to which such interventions address different elements of understanding in informed consent. . To systematically review communication interventions to improve patient comprehension in informed consent for medical and surgical procedures. Data Sources. A systematic literature search of English-language articles in MEDLINE (1949-2008) and EMBASE (1974-2008) was performed. In addition, a published bibliography of empirical research on informed consent and the reference lists of all eligible studies were reviewed. Study Selection. Randomized controlled trials and controlled trials with nonrandom allocation were included if they compared comprehension in informed consent for a medical or surgical procedure. Only studies that used a quantitative, objective measure of understanding were included. All studies addressed informed consent for a needed or recommended procedure in actual patients. Data Extraction. Reviewers independently extracted data using a standardized form. All results were compared, and disagreements were resolved by consensus. Data Synthesis. Forty-four studies were eligible. Intervention categories included written information, audiovisual/multimedia, extended discussions, and test/feedback techniques. The majority of studies assessed patient understanding of procedural risks; other elements included benefits, alternatives, and general knowledge about the procedure. Only 6 of 44 studies assessed all 4 elements of understanding. Interventions were generally effective in improving patient comprehension, especially regarding risks and general knowledge. Limitations. Many studies failed to include adequate description of the study population, and outcome measures varied widely. . A wide range of communication interventions improve comprehension in clinical informed consent. Decisions to enhance informed consent should consider the importance of different elements of understanding, beyond procedural risks, as well as feasibility and acceptability of the intervention to clinicians and patients. Conceptual clarity regarding the key elements of informed consent knowledge will help to focus improvements and standardize evaluations.

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A Review of Key Likert Scale Development Advances: 1995–2019

Andrew Jebb, Vincent Ng, Louis Tay (2021)

Developing self-report Likert scales is an essential part of modern psychology. However, it is hard for psychologists to remain apprised of best practices as methodological developments accumulate. To address this, this current paper offers a selective review of advances in Likert scale development that have occurred over the past 25 years. We reviewed six major measurement journals (e.g., Psychological Methods , Educational , and Psychological Measurement ) between the years 1995–2019 and identified key advances, ultimately including 40 papers and offering written summaries of each. We supplemented this review with an in-depth discussion of five particular advances: (1) conceptions of construct validity, (2) creating better construct definitions, (3) readability tests for generating items, (4) alternative measures of precision [e.g., coefficient omega and item response theory (IRT) information], and (5) ant colony optimization (ACO) for creating short forms. The Supplementary Material provides further technical details on these advances and offers guidance on software implementation. This paper is intended to be a resource for psychological researchers to be informed about more recent psychometric progress in Likert scale creation.

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Author and article information

Contributors

Güliz Acker:

ORCID: http://orcid.org/0000-0002-8946-6426

gueliz.acker@charite.de

Journal

Journal ID (nlm-ta): Acta Neurochir (Wien)

Journal ID (iso-abbrev): Acta Neurochir (Wien)

Title: Acta Neurochirurgica

Publisher: Springer Vienna (Vienna )

ISSN (Print): 0001-6268

ISSN (Electronic): 0942-0940

Publication date (Electronic): 28 February 2023

Publication date PMC-release: 28 February 2023

Publication date (Print): 2023

Volume: 165

Issue: 4

Pages: 1087-1098

Affiliations

[1 ]GRID grid.6363.0, ISNI 0000 0001 2218 4662, Department of Neurosurgery, , Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ; Charitéplatz 1, 10117 Berlin, Germany

[2 ]GRID grid.7468.d, ISNI 0000 0001 2248 7639, Cluster of Excellence: “Matters of Activity. Image Space Material”, , Humboldt-Universität Zu Berlin, ; 10099 Berlin, Germany

[3 ]GRID grid.6363.0, ISNI 0000 0001 2218 4662, Institute of Biometry and Clinical Epidemiology, , Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ; Charitéplatz 1, 10117 Berlin, Germany

[4 ]GRID grid.484013.a, ISNI 0000 0004 6879 971X, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, ; Charitéplatz 1, 10117 Berlin, Germany

[5 ]GRID grid.6363.0, ISNI 0000 0001 2218 4662, Institute of Medical Informatics, , Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ; Charitéplatz 1, 10117 Berlin, Germany

[6 ]GRID grid.484013.a, ISNI 0000 0004 6879 971X, BIH Academy, Clinician Scientist Program, , Berlin Institute of Health at Charité – Universitätsmedizin Berlin, ; Charitéplatz 1, 10117 Berlin, Germany

Author information

Nicolas Hertzsprung http://orcid.org/0000-0002-6115-3946

Thomas Picht http://orcid.org/0000-0002-8630-1466

Anna L. Roethe http://orcid.org/0000-0002-5742-6091

Kerstin Rubarth http://orcid.org/0000-0002-6174-6346

Peter Vajkoczy http://orcid.org/0000-0003-4350-392X

Güliz Acker http://orcid.org/0000-0002-8946-6426

Article

Publisher ID: 5512

DOI: 10.1007/s00701-023-05512-x

PMC ID: 10068664

PubMed ID: 36853569

SO-VID: 7b818aae-915f-4fab-abfc-273a8ca032e4

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 10 October 2022

Date accepted : 13 January 2023

Funding

Funded by: Charité - Universitätsmedizin Berlin (3093)

Open Access :

Open Access funding enabled and organized by Projekt DEAL.

Custom metadata

ScienceOpen disciplines: Surgery

Keywords: 3d,stereoscopic,neurosurgery,surgical informed consent,patient education

Data availability:

ScienceOpen disciplines: Surgery

Keywords: 3d, stereoscopic, neurosurgery, surgical informed consent, patient education

Personalized surgical informed consent with stereoscopic visualization in neurosurgery—real benefit for the patient or unnecessary gimmick?

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Abstract

Background

Methods

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Supplementary Information

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25th European Students' Conference

Most cited references 37

3D-printing techniques in a medical setting: a systematic literature review

Interventions to improve patient comprehension in informed consent for medical and surgical procedures: a systematic review.

A Review of Key Likert Scale Development Advances: 1995–2019

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