Comic illustrations enhance informed consent before coronary angiography

A new pilot study out of Germany suggests a comic-style graphic supplement can improve the informed consent process before coronary angiography by putting patients at ease and helping them understand the procedure.

Anna Brand, MD, and colleagues randomized 121 patients who were having coronary angiography at Charité-Universitätsmedizin Berlin to receive standard informed consent (IC) or the same information with an additional comic-type narrative based on key elements of the official consent form.

Compared to those receiving standard IC, the patients who were also given the graphical illustrations showed:

  • Better understanding of the intervention (11.5 vs 9.1 points on a 13-point quiz).
  • Reduced anxiety following informed consent based on the Spielberger State-Trait Anxiety Inventory—patients’ anxiety in the standard IC group increased two points while anxiety decreased 3.1 points in the comic group after informed consent.
  • Greater satisfaction following informed consent (27.7 vs 25.2 points on a 32-point scale) and coronary angiography (27.8 vs 25.3 points on the same scale).
  • A higher likelihood of agreeing they felt “well prepared” for cardiac catheterization (71.7% vs 41%).

“Our results suggest beneficial effects of medical graphic narratives on patient comprehension, anxiety, and satisfaction,” Brand et al. wrote in the Annals of Internal Medicine. “The use of complementary graphic illustrations may substantially improve the practice of patient IC.”

The researchers pointed to another recent study which found an educational video boosted patients’ knowledge and satisfaction prior to undergoing angiography.

“Both comic- and video-assisted patient information enable simultaneous cognitive processing of visual and narrative information, which has been shown to improve comprehension of complex processes in distinct learner types (contiguity effect),” Brand and co-authors wrote. “An advantage of comic-based approaches is that they allow each patient to acquire and process information at his or her own speed, so patients can reread and reflect on paragraphs with complex information as individually needed.”

The study was limited by its small sample size and single-center design, the authors acknowledged. They suggested larger, multicenter trials be conducted to further investigate whether comic-based supplements can improve the informed consent process.