Medical Graphic Narratives to Improve Patient Comprehension and Periprocedural Anxiety Before Coronary Angiography and Percutaneous Coronary Intervention: A Randomized Trial
Authors: Anna Brand, Linde Gao, Alexandra Hamann, Claudia Crayen, Hannah Brand, Susan M. Squier, Karl Stangl, Friederike Kendel, Verena Stangl
Journal: Annals of Internal Medicine (2019)

Letters16 April 2019Medical Graphic Narratives to Improve Patient Comprehension and Periprocedural Anxiety Before Coronary Angiography and Percutaneous Coronary Intervention: A Randomized TrialAnna Brand, MD, Linde Gao, MD, Alexandra Hamann, Claudia Crayen, PhD, Hannah Brand, Susan M. Squier, PhD, Karl Stangl, MD, Friederike Kendel, PhD, and Verena Stangl, MDAnna Brand, MDCharité – Universitätsmedizin Berlin and DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany (A.B., K.S., V.S.), Linde Gao, MDCharité – Universitätsmedizin Berlin, Berlin, Germany (L.G., H.B., F.K.), Alexandra HamannMintwissen, Berlin, Germany (A.H.), Claudia Crayen, PhDFreie Universität Berlin, Berlin, Germany (C.C.), Hannah BrandCharité – Universitätsmedizin Berlin, Berlin, Germany (L.G., H.B., F.K.), Susan M. Squier, PhDPennsylvania State University, University Park, Pennsylvania (S.M.S.), Karl Stangl, MDCharité – Universitätsmedizin Berlin and DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany (A.B., K.S., V.S.), Friederike Kendel, PhDCharité – Universitätsmedizin Berlin, Berlin, Germany (L.G., H.B., F.K.), and Verena Stangl, MDCharité – Universitätsmedizin Berlin and DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany (A.B., K.S., V.S.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-2976 SectionsSupplemental MaterialAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Written informed consent (IC) before such interventions as coronary angiography may not ensure that patients understand the rationale, procedural details, and potential risks involved. Barriers include patient anxiety, literacy, and differences in clinicians' communication skills. Medical graphic narratives ("comics") may communicate complex health information more clearly.Objective: To assess whether supplementing standard IC (ICstandard) with a comic (ICcomic) improves patient comprehension, anxiety, and satisfaction.Methods: From October 2016 to January 2018, a total of 135 consecutive hospitalized patients who were having coronary angiography at Charité – Universitätsmedizin Berlin, Campus Mitte, were screened for enrollment. Of these patients, 121 were ...References1. Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al; ESC Scientific Document Group. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J. 2019;40:87-165. [PMID: 30165437] doi:10.1093/eurheartj/ehy394 CrossrefMedlineGoogle Scholar2. Chandrasekharan DP, Taggart DP. Informed consent for interventions in stable coronary artery disease: problems, etiologies, and solutions. Eur J Cardiothorac Surg. 2011;39:912-7. [PMID: 20934881] doi:10.1016/j.ejcts.2010.08.033 CrossrefMedlineGoogle Scholar3. Lattuca B, Barber-Chamoux N, Alos B, Sfaxi A, Mulliez A, Miton N, et al; INFOCORO investigators. Impact of video on the understanding and satisfaction of patients receiving informed consent before elective inpatient coronary angiography: a randomized trial. Am Heart J. 2018;200:67-74. [PMID: 29898851] doi:10.1016/j.ahj.2018.03.006 CrossrefMedlineGoogle Scholar4. Mayer RE, Sims VK. For whom is a picture worth a thousand words? Extensions of a dual-coding theory of multimedia learning. Journal of Educational Psychology. 1994;86:389-401. CrossrefGoogle Scholar5. Houts PS, Doak CC, Doak LG, Loscalzo MJ. The role of pictures in improving health communication: a review of research on attention, comprehension, recall, and adherence. Patient Educ Couns. 2006;61:173-90. [PMID: 16122896] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Charité – Universitätsmedizin Berlin and DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany (A.B., K.S., V.S.)Charité – Universitätsmedizin Berlin, Berlin, Germany (L.G., H.B., F.K.)Mintwissen, Berlin, Germany (A.H.)Freie Universität Berlin, Berlin, Germany (C.C.)Pennsylvania State University, University Park, Pennsylvania (S.M.S.)See Also: The graphic narrative used in the trial is published in Annals Graphic Medicine at Annals.org: Brand A, Gao L, Hamann A, Martineck S, Stangl V. Annals Graphic Medicine - Patient-informed consent. Ann Intern Med. 2019;170:W90-W106. doi:10.7326/G19-0008. Available at www.annals.org/aim/article/doi/10.7326/G19-0008.Acknowledgment: We thank Sophia Martineck for illustrations, and the Friede Springer Herz Stiftung, Berlin, for funding.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2976.Data Sharing Statement: The following data will be made available with publication: deidentified participant data and data dictionary (e-mail, anna.[email protected]de). These data will be made available for researchers whose proposed use of the data has been approved (e-mail, anna.[email protected]de).This article was published at Annals.org on 9 April 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals Graphic Medicine - Patient-Informed Consent Anna Brand , Linde Gao , Alexandra Hamann , Sophia Martineck , and Verena Stangl Annals Graphic Medicine - Patient-Informed Consent Anna Brand , Linde Gao , Alexandra Hamann , Sophia Martineck , and Verena Stangl Metrics Cited byGraphic Medicine and Radiology Nursing: Using Comics for Education and Stress MitigationEffects of Xinkeshu tablets on coronary heart disease patients combined with anxiety and depression symptoms after percutaneous coronary intervention: A meta-analysisInformed Consent before coronary angiography and percutaneous coronary intervention from the patient's perspective: A picture is worth a thousand wordsGraphic narrative based informed consent for bronchoscopy improves satisfaction in patients after lung-transplantation: A randomized controlled trialLiteraturverzeichnisA Review of the Evidence and Recommendations on Communication Skills and the Patient–Provider Relationship: A Rome Foundation Working Team ReportAnästhesiologisches Management der perioperativen SchmerztherapieGraphic Narrative Versus Journal Article for Teaching Medical Students About P Values: A Randomized TrialPreprocedural Anxiety in the Transradial Cardiac Catheterization EraEffectiveness and safety of Xinkeshu on coronary artery disease patients combined with anxiety and depression symptoms after percutaneous coronary interventionRemote monitoring of cardiac implanted electronic devices: legal requirements and ethical principles - ESC Regulatory Affairs Committee/EHRA joint task force reportAnimation-supported consent for urgent angiography and angioplasty: a service improvement initiativeStrategies for Successful Learning with Geographical Comics: An Eye-Tracking Study with Young LearnersInteractions between Medicine and the ArtsExtending Patient Education with CLAIRE: An Interactive Virtual Reality and Voice User Interface ApplicationAnnals Graphic Medicine - Patient-Informed ConsentAnna Brand, MD, Linde Gao, MD, Alexandra Hamann, Sophia Martineck, and Verena Stangl, MD 16 April 2019Volume 170, Issue 8Page: 579-581KeywordsAngiographyAnxietyDisclosureHealth information technologyLiteracyPerceptionPercutaneous coronary interventionQuestionnairesRandomized trialsRevascularization ePublished: 9 April 2019 Issue Published: 16 April 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. 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