Impact of video-assisted informed consent on decision conflict and consultation time in gastric cancer surgery

Table 1 Contents of video aids for informed consent in gastrectomy

	Details
General	Function of the stomach; gastric cancer (stage, invasion, metastasis, symptoms)
Surgical approaches	Open surgery; laparoscopic surgery; robotic surgery
Type of procedures	Total gastrectomy (Roux-en-Y/double-tract reconstruction/jejunal interposition); proximal gastrectomy (esophagogastrostomy/double-tract reconstruction/jejunal interposition); distal gastrectomy (Billroth I/Billroth II/Roux-en-Y reconstruction)
Postoperative complications	Postoperative complications; pancreatic fistula; anastomotic leak; dumping syndrome
Postoperative course	Postoperative lifestyle; dumping syndrome

Table 2 Patient characteristics and surgical procedures, n (%)

	PVIC1 group (n = 30)	SIC2 group (n = 30)	P value
Age, median (interquartile range), years	64.0 (54.8-69.3)	66.0 (49.5-73)	0.187
Sex
Male	10 (33.3)	10 (33.3)	1.000
Female	20 (66.7)	20 (66.7)
ASA-PS
1	5 (16.7)	1 (3.3)	0.197
2	25 (83.3)	29 (96.7)
Stage
I	22 (73.3)	27 (90)	0.135
II	5 (16.7)	3 (10)
III	3 (10)	0 (0)
Type of resection
DG	27 (90)	21 (70)	0.153
PG	2 (6.7)	6 (20)
TG	1 (3.3)	3 (10)
Lymph node dissection
D1+	16 (53.3)	19 (63.3)	0.431
D2	14 (46.7)	11 (36.7)

¹Pre-consultation video informed consent group comprised patients who viewed the video before in-person informed consent consultation.

²Standard informed consent group comprised patients who first underwent an in-person informed consent consultation, followed by supplementary video viewing.

PVIC: Pre-consultation video informed consent; SIC: Standard informed consent; ASA-PS: American Society of Anesthesiologists Physical Status; DG: Distal gastrectomy; PG: Proximal gastrectomy; TG: Total gastrectomy.

Table 3 Endpoints

	PVIC1 group, (n = 30)	SIC2 group, (n = 30)	P value
Primary endpoint
DCS score, mean (95%CI)	13.5 (8.5-18.6)	20.5 (15.4-25.6)	0.056
Secondary endpoints
DCS score ≥ 37.53, n (%)	0 (0)	6 (20)	0.0244
IC time, mean (95%CI), minutes	22.4 (18.8-26.0)	35.9 (32.3-39.5)	< 0.0014

¹The pre-consultation video informed consent group consists of patients who viewed the video before the in-person informed consent consultation.

²The standard informed consent group consists of patients who first underwent an in-person informed consent consultation, followed by supplementary video viewing.

³A decisional conflict scale score ≥ 37.5 was defined as patients with high decision conflict.

⁴Statistically significant.

PVIC: Pre-consultation video informed consent; SIC: Standard informed consent; DCS: Decision conflict scale; CI: Confidence interval; IC: Informed consent.

Table 4 Decision conflict scale scores and proportion of patients with high decision conflict (decision conflict scale score ≥ 37.5)

PVIC1 group	T1 after video aids, (n = 30)	T2 after in-person IC, (n = 30)	P value
DCS score, mean (95%CI)	19.0 (14.3-23.7)	13.5 (8.5-18.6)	0.0024
DCS score ≥ 37.52, n (%)	2 (6.7)	0 (0)	0.150
SIC3 group	T1 after in-person IC, (n = 30)	T2 after video aids, (n = 30)	P value
DCS score, mean (95%CI)	20.5 (15.4-25.6)	12.4 (8.0-16.9)	< 0.0014
DCS score ≥ 37.52, n (%)	6 (20)	2 (6.7)	0.129

¹The pre-consultation video informed consent group consists of patients who viewed the video before the in-person informed consent consultation.

²A decision conflict scale score ≥ 37.5 was defined as patients with high decision conflict.

³The standard informed consent group consists of patients who first underwent an in-person informed consent consultation, followed by supplementary video viewing.

⁴Statistically significant.

PVIC: Pre-consultation video informed consent; IC: Informed consent; DCS: Decision conflict scale; CI: Confidence interval; SIC: Standard informed consent.

Table 5 Surgical outcomes, n (%)/median (interquartile range)

	PVIC1 group (n = 30)	SIC2 group (n = 30)	P value
Operative time, minutes	371 (326-481)	396 (347-470)	0.201
Volume of blood loss, mL	23.5 (10.8-55.8)	27.5 (10.8-49.3)	0.953
Stage I-IV	20/6/3/1	20/7/2/1	0.766
Postoperative complication, ≥ C-D grade III	1 (3.3)	3 (10)	0.612
Dumping syndrome3	1 (3.3)	3 (10)	0.612
Adjuvant chemotherapy	9 (30)	5 (16.7)	0.360
Length of hospital stay, day	12 (11-14)	10 (9-16)	0.191

¹The pre-consultation video informed consent group comprised patients who viewed the video before the in-person informed consent consultation.

²The standard informed consent group comprised patients who first underwent an in-person informed consent consultation, followed by supplementary video viewing.

³Dumping syndrome during hospitalization: Patients with dumping syndrome did not overlap with those who had complications of Clavien-Dindo grade ≥ III.

PVIC: Pre-consultation video informed consent; SIC: Standard informed consent; C-D: Clavien-Dindo classification.