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Comic-style information can better prepare surgical patients

Patients who received comic-style information better understood what the procedure entailed and were less anxious

Ingrid Torjesen

Wednesday, 17 April 2019

Providing patients with information about their forthcoming surgical procedure in comic style can help them better understand what the procedure involves and reduce their anxiety, a study* published in the Annals of Internal Medicine found.

Patients undergoing surgery must be fully informed about what the procedure entails, the potential risks and the likely benefits, so that they can give informed consent. However, patients with coronary heart disease have been shown to not fully grasp the basic procedural steps involved in cardiac catheterisation even after undergoing this informed consent procedure, because the complex nature of the information provided leaves them feeling overwhelmed. Researchers from Charité – Universitätsmediz in Berlin tried providing patients scheduled to undergo cardiac catheterization with the necessary information in comic-style format.


"Inspired by the notion that 'a picture is worth more than a thousand words', we wanted to use graphical representations to help patients understand the procedural details provided as part of the informed consent procedure," explained Professor Dr Verena Stangl of the Medical Department, Division of Cardiology and Angiology on Campus Charité Mitte.

The researchers developed a 15-page comic-style booklet which explains the most common procedure in the field of cardiology - cardiac catheterization, followed by (where required) the insertion of a stent to open a narrowed or blocked artery.

"What our pilot study showed was patients who received this comic-style felt better prepared for surgery," explained Professor Stangl.

The researchers recruited a total of 121 patients scheduled to undergo cardiac catheterisation. Patients then either underwent the standard informed consent procedure or standard informed consent with additional comic-style information. Using a range of questionnaires, which were administered both before and after the informed consent procedure, the researchers then assessed levels of comprehension and anxiety as well as satisfaction with the consenting process.

The comic-style booklet proved useful in all three categories. When presented with questions on procedural details, risks and postoperative advice, patients who received the comic-style information booklet were able to provide on average correct answers to nearly 12 out of a total of 13 questions while those who had undergone the usual consent procedure scored approximately nine.

Patients in the comic-style information group also reported feeling less anxious after their informed consent procedure. Overall, approximately 72% of participants were satisfied with the comic-based information booklet and reported feeling well prepared for cardiac catheterisation compared with only 41% of those in the standard informed consent group.

"A comic-style presentation enables the simultaneous visual and textual processing of complex information. This has been shown to enhance comprehension in different learner types," said Dr. Anna Brand, the study's other lead investigator.

"The comic-based approach also enables readers to process the information presented at their own speed.

“For the first time, our study showed that comic-based medical information can be a highly effective addition to the medical consenting process. We want to use future research to test whether similar positive effects can be achieved in patients undergoing other medical procedures."


*Brand A, Gao L, Hamann A, Crayen C, et al. Medical Graphic Narratives to Improve Patient Comprehension and Periprocedural Anxiety Before Coronary Angiography and Percutaneous Coronary Intervention: A Randomized Trial. Ann Intern Med. 2019;170:579–581. doi: 10.7326/M18-2976

Image courtesy of Brand, Gao, Hamann, Martineck, Stangl/Charité

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