University of Texas Health at San Antonio, University Health System Used AHRQ Tools

The University of Texas Health at San Antonio (UT Health SA) used three AHRQ tools as the basis for developing a multimedia decision aid to help patients fully understand and consent to the placement of peripherally inserted central catheters, or PICC lines. The decision aid, which incorporates AHRQ’s Making Informed Consent an Informed Choice guide, Health Literacy Universal Precautions Toolkit, and Patient Educational Materials Assessment Tool Guide, was found to be more effective in helping patients understand and retain information about the procedure than the standard consent process.

Once a prototype of the new decision aid was complete, a study compared two groups of patients: one using the multimedia patient decision aid as a support for the informed consent process and the other using the standard consent process for PICC lines. A total of 128 patients (63 in the intervention, 65 in the control group) in 10 acute and intensive care units were surveyed for their knowledge recall, knowledge retention, satisfaction with the consent process, and satisfaction with the multimedia patient decision aid.

Patients surveyed gave responses ranked on a 5-point scale, ranging from very satisfied (5) to very unsatisfied (1). The patients who used the multimedia decision aid tool scored higher on knowledge recall and retention (4.9 and 4.8) compared with those using the standard consent process (4.7 and 4.6). The highest scores were achieved in knowledge retention (4.9), willingness to learn (4.8), complete understanding of potential complications (4.8), and the patients’ role in maintaining the safety of the PICC (4.8), according to Azizeh K. Sowan, R.N., Ph.D., associate professor at UT Health SA’s School of Nursing. She conducted the project at University Health System, the primary affiliated teaching hospital.   

Nurses from the vascular access team at the hospital must get signed informed consent statements from approximately 250 patients a month who need a PICC. This procedure is performed for conditions that require intravenous medications, nutrition, and fluids. 

Getting informed consent has important ethical, legal, and clinical implications for patients and clinicians. For patients undergoing a PICC procedure, for example, the informed consent process helps them understand why it is recommended, the risks and benefits, and possible treatment alternatives. It also gives clinicians a better sense of patients’ preferences and their understanding of how to maintain the safety of the PICC line.

Dr. Sowan explained that the previous standard consent process at University Health System was problematic. The process required patients who need PICC lines to review informed consent materials with medical jargon and language “that made it really hard to understand” the procedure, she said. 

Finding few examples of evidence-based, multimedia patient decision aids in the medical literature, Dr. Sowan and the hospital team began to develop and test one of their own in English and Spanish.

Led by Dr. Sowan in collaboration with University Health System clinicians and leaders, the decision aid was created, implemented, and modified using the AHRQ’s Making Informed Consent an Informed Choice guide. The team incorporated plain language, teach-back concepts, and criteria in AHRQ’s Health Literacy Universal Precautions Toolkit and AHRQ’s Patient Educational Materials Assessment Tool Guide, which is a method to evaluate the understandability of patient education materials. Dr. Sowan said the team found the guide to be helpful in making the decision aid comprehensive. “We went through every single part of the process,” she noted.

The hospital’s experience with the new decision aid prompted the team to think about other ways the AHRQ tools could be used.

“The benefits of the new decision aid on University Health System’s informed consent process will extend beyond patients undergoing PICC procedures,” Dr. Sowan said. Plans are underway to use it for seven other procedures.