Back to the future: surgical rehearsal platform technology as a means to improve surgeon-patient alliance, patient satisfaction, and resident experience

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  • 1 Department of Neurological Surgery and
  • 3 Neurological and Behavioral Outcomes Center, Department of Psychiatry, University Hospitals Cleveland Medical Center; and
  • 2 Case Western Reserve University School of Medicine, Cleveland, Ohio
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OBJECTIVE

Informed consent, when performed appropriately, serves many roles beyond simply obtaining the prerequisite medicolegal paperwork to perform a surgery. Prior studies have suggested that patient understanding is poor when verbal communication is the sole means of education. Virtual reality platforms have proven effective in enhancing medical education. No studies exist that have demonstrated the utility of virtual reality–facilitated informed consent (VR-IC) in improving the physician-patient alliance. The aim of this study was to determine the utility of VR-IC among patients providing consent for surgery and the impact of this educational and information technology–based strategy on enhancing the physician-patient alliance, patient satisfaction, and resident-physician perception of the consent process.

METHODS

Prospective, single-site, pre- and postconsent surveys were administered to assess patient and resident perception of informed consent performed with the aid of VR-IC at a large tertiary academic medical center in the US. Participants were adult patients (n = 50) undergoing elective surgery for tumor resection and neurosurgical residents (n = 19) who obtained patient informed consent for these surgical procedures. Outcome measures included scores on the Patient-Doctor Relationship Questionnaire (PDRQ-9), the modified Satisfaction with Simulation Experience Scale, and the Maslach Burnout Inventory. Patient pre- and postconsent data were recorded in real time using a secure online research data platform (REDCap).

RESULTS

A total of 48 patients and 2 family members provided consent using VR-IC and completed the surveys pre- and postconsent; 47.9% of patients were women. The mean patient age was 57.5 years. There was a statistically significant improvement from pre- to post–VR-IC consent in patient satisfaction scores. Measures of patient-physician alliance, trust, and understanding of their illness all increased. Among the 19 trainees, perceived comfort and preparedness with the informed consent process significantly improved.

CONCLUSIONS

VR-IC led to improved patient satisfaction, patient-physician alliance, and patient understanding of their illness as measured by the PDRQ-9. Using VR-IC contributed to residents’ increased comfort in the consent-gathering process and handling patient questions. In an era in which satisfaction scores are directly linked with hospital and service-line outcomes and reimbursement, positive results from VR-IC may augment physician and hospital satisfaction scores in addition to increasing measures of trust between physicians and patients.

ABBREVIATIONS PDRQ = Patient-Doctor Relationship Questionnaire; PGY = postgraduate year; SRP = surgical rehearsal platform; SSES = Satisfaction with Simulation Experience Scale; VR-IC = virtual reality–facilitated informed consent.

Supplementary Materials

    • pdf Visual Abstract (PDF 1.29 MB)

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Contributor Notes

Correspondence James M. Wright: University Hospitals Cleveland Medical Center, Cleveland, OH. jmonroewright@gmail.com.

INCLUDE WHEN CITING Published online October 23, 2020; DOI: 10.3171/2020.6.JNS201865.

J.M.W. and A.R. share first authorship of this work.

Disclosures Dr. Sajatovic: consultant for Alkermes, Otsuka, Janssen, Neurocrine, Bracket, Health Analytics, and Frontline Medical Communications; royalties from Springer Press, Johns Hopkins University Press, Oxford Press, and UpToDate; clinical or research support for the study described from Nuromate, Otsuka, Alkermes, and the International Society for Bipolar Disorders (ISBD); and compensation for preparation of CME activities from the American Physician Institute, MCM Education, CMEology, the Potomac Center for Medical Education, Global Medical Education, Creative Educational Concepts, and the Psychopharmacology Institute. Dr. Selman: investor in and cofounder of Surgical Theater.

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