Using digital pre-op information to support informed consent (by Julie Smith)

Summary

Digital delivery of information is the new normal and it’s important that healthcare providers adapt quickly. Informed consent in the UK needs to be backed up by the BRAN principle: Benefits, Risks and Alternatives including the option of doing Nothing. 

In this blog, Julie Smith, Content Director at EIDO Healthcare, will use the same principles to consider the use of digital solutions for patient information. This blog is not exhaustive but will hopefully provide some food for thought around the patient safety considerations relating to digital information. 

Content

Benefits

Patient experience

A study published in the World Journal of Surgery[1] earlier this year assessed digital delivery of informed consent information. The authors concluded that the system reduced the number of hospital appointments needed and improved the quality of in-person consultations. Most importantly, participants felt empowered to make an informed decision:

‘The information was felt to be “easy to read and navigate”, and made users feel that they were a part of the shared decision-making process. One user stated that, “The process makes me feel responsible for making a good decision about my own health care”.'

Digital delivery of information offers accessibility features to help those in need. Screen readers can read content out loud and font style and size can be adjusted for better visibility. Importantly, these are features that do not rely on patients having to specifically request the format that meets their requirements. They can simply toggle it on or off.

To enhance the written content, animations and videos can be embedded with voiceovers and captions in different languages. Risk rates, which are often difficult to communicate, can be better presented with data visualisations or pictographs. This flexibility is not as easy to achieve in printed information and all patients, regardless of need, will often receive the same version.

Resources

In terms of time and money, the savings potential of digital information is huge.[2] A paperless, digitised NHS has failed to materialise despite numerous policies and targets. Moving pre-operative patient information online would represent huge savings on printing costs and would help trusts get closer to those elusive paperless targets. It would also, of course, be better for the environment.

Recording and reviewing

Digital solutions offer a more accurate and reliable system of record keeping. Some platforms can actually track a patient’s activity. This means health professionals have an insight into how much time the patient has spent reading the information, right down to each section.

In practice, this means the surgeon knows which areas the patient spent the most or least time on, and so can focus on those areas in the consultation. Health professionals can also quickly see what information has been sent to which patient and when. Most solutions connect to electronic patient records, allowing for seamless record keeping – something that paper-based solutions can sometimes fail on.

Printed information has a shelf life. In some cases, it can become out of date within weeks. This was especially true at the height of the Covid-19 pandemic, when pre- and post-operative advice and information was changing regularly. If the information is kept digitally, it can be updated in real time. This means that when the health professional or patient visits the supplied link, they will be seeing the most up-to-date version.

Risks

Digital exclusion

The Covid-19 pandemic catapulted many of us to a level of digital literacy that otherwise would probably have taken many years. Zoom calls, QR codes and online appointments became the status quo, and even though the pandemic is over, these, along with many other technologies, are here to stay. However, it is important to recognise that digital literacy and access are still out of reach for a significant percentage of the UK population. According to the 2022 Lloyds Bank Consumer Digital Index:[3]

‘Around 5 million (10%) cannot use an app and 4.5 million (8%) cannot turn on a device and enter login information by themselves. Overall, 5.3 million (10%) of the UK, lack both the digital basics and the essential digital skills for everyday life.’

There is a distinct difference in age groups, with 48% of 18 to 24-year-olds reporting using the Internet for managing their physical health. This number declined as respondents got older, with just 27% using it for that reason in the 60+ age bracket. This is important to note as the surgical population in England is ageing and at a faster rate than the general population.[4] So, those most likely to need surgery are also less likely to be digitally literate.

This is an important consideration for health professionals supplying patient information. Accessible versions should always be made available and for a lot of people this will be in print. Focus should also be on education about and access to digital information to ensure no one is left behind. There is some great work being done in this area by organisations like the Good Things Foundation.

At EIDO Healthcare, we continue to supply information in print and currently this is the most used format. However, we do expect so see a shift towards digital content in time.

Connectivity and cyber attacks

Internet connections must be stable in order to issue and access digital information and data privacy rules and regulations must be observed. Health providers have a responsibility to have contingencies in place for network outages and breaches. However, this cannot always be guaranteed so back-up systems must be in place at all times.

The NHS has been a victim of a number of cyber attacks that present a serious patient safety risk. In 2017 a global cyber attack impacted GP practices and hospitals across England and Scotland[5] and in August 2022 another attack meant NHS staff in some trusts were unable to access patient notes for a number of weeks.[6] In 2021 Ireland suffered the largest ever attack on a health service computer system.[7] Some 90,000 people were affected.

As a result of these attacks, healthcare organisations are investing huge amounts in preventative and reactive measures; however, this is still a risk that must be considered.

Alternatives, including doing Nothing

In this scenario, doing nothing would amount to sticking to the status quo. If the NHS and other healthcare providers chose to ‘do nothing’ and continue with current paper-based systems there would likely be no immediate or obvious adverse effect. Many trusts are still giving patients print outs and it will be some time before they move to digital. However, the indirect effect of never moving to digital will be the continued delays to treatment as time is spent on waiting for and carrying out lengthy face-to-face consultations. More than ever, the NHS is under pressure to find ways of saving time and money. Doing nothing will result in the opposite outcome.

Final thoughts

EIDO patient information leaflets all have the same final paragraph, and I think it can be applied here, with a few tweaks:

Digital solutions are usually safe and effective but complications can happen. You need to know about them to help you to make an informed decision about using them. Knowing about them will also help to detect and treat any problems early.

References

1. Parsons SL, Daliya, P, Evans P. et al. Digital Informed Consent: Modernising Information Sharing in Surgery to Empower Patients. World J Surg. 2023.
2. Brother UK. What's stopping the NHS going digital? 2021.
3. Lloyds Bank. UK Consumer Digital Index 2022. 2022.
4. Fowler A, Abbott T, Prowle J et al. Age of patients undergoing surgery. Br J Surg. 2019:8.
5. Comptroller and Auditor General. Investigation: WannaCry cyber attack and the NHS. National Audit Office. 2018.
6. Thomas R. Cyberattack: NHS staff unable to access patient notes for three weeks. Independent online. 2022. 
7. Health Service Executive. Cyber-attack and HSE response. 

Related reading

• Accessible patient information: a key element of informed consent
• Long surgical waiting lists: improving outcomes with patient information
• Informed consent: what is it?

About the Author

Julie Smith is the Content Director at EIDO Healthcare. She oversees a library of leaflets used to support patients in making informed decisions about their care, with a focus on medical procedures and operations. Julie and her team are trained in Plain English, risk communication, easy-read information, translation processes and more.

Julie is a healthcare editor by background and previously worked at MA Healthcare as Editorial Director, overseeing 25 healthcare journals. She is a member of the PIF TICK steering group and a Trustee and Board Member of the Lindsay Leg Club Foundation.