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The research to practice continuum: Development of an evidence-based visual aid to improve informed consent for procedural sedation

  • M. Fernanda Bellolio (a1) (a2), Lucas Oliveira J. e Silva (a1) (a3), Henrique Alencastro Puls (a4), Ian G. Hargraves (a5) (a6) and Daniel Cabrera (a1)...
Abstract
Introduction

In order to fully participate in informed consent, patients must understand what it is that they are agreeing, or not agreeing, to. In most cases, patients look to their clinicians to help develop the appropriate understanding required to give informed consent. Often the quality of the information available as well as the delivery methods are not optimal.

Methods

Using a visual aid as an adjunct to risk communication in a stressful setting as the Emergency Department has a clear potential in facilitating the communication process. To support more accurate and consistent presentation of risk, we formed a team with implementation scientists, patient education specialists, nurses, physicians, and professional designers to transform the information available into a 6th grade reading level visual aid tool. We applied a DMAIC (Define, Measure, Analyze, Improve and Control) process to design the tool. We measured and analyzed its effectiveness through feedback from providers, patients, and caregivers. This cycle happened 3 times until we reached the final version of the visual aid.

Results

We utilized a DMAIC methodology as well as modified Delphi method to create and refine a visual aid tool. Several rounds of end-user feedback along with DMAIC allowed us to create a tool that was consistently better with each round of development, analysis and feedback. After arriving at the final version of the tool, we surveyed physicians in our Emergency Department. We measured the difficulty to understand the information, whether doctors think the visual aid will help patients to understand the data, and the appropriateness of the tool’s length and the amount of information in it.

Conclusions

We believe that our experience can be replicated by other researchers and clinicians in the endeavor of translating the evidence into clinical practice. An effort should be made to fully translate research findings until the end of the research to practice continuum in order to better translate knowledge into a useful and useable form for informed consent decisions in busy clinical practice.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
Corresponding author
*Address for correspondence: M. F. Bellolio, M.D., M.S., Emergency Medicine, Mayo Clinic, 200 First Street SW, Generose G-410, Rochester, MN 55905, USA. (Email: bellolio.fernanda@mayo.edu)
References
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1. Bellolio, MF, et al. Incidence of adverse events in paediatric procedural sedation in the emergency department: a systematic review and meta-analysis. British Medical Journal 2016; 6: e011384.
2. Bellolio, MF, et al. Incidence of adverse events in adults undergoing procedural sedation in the emergency department: a systematic review and meta-analysis. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine 2016; 23: 119134.
3. Zipkin, DA, et al. Evidence-based risk communication: a systematic review. Annals of Internal Medicine 2014; 161: 270280.
4. Guyatt, G, et al. Evidence-based medicine: a new approach to teaching the practice of medicine. JAMA. 1992; 268: 24202425.
5. Sackett, DL, et al. Evidence based medicine: what it is and what it isn’t. British Medical Journal 1996; 312: 7172.
6. Haynes, RB, Devereaux, PJ, Guyatt, GH. Physicians’ and patients’ choices in evidence based practice: evidence does not make decisions, people do. British Medical Journal 2002; 324: 13501350.
7. Lang, E. Finding one’s way in translating evidence into practice. Annals of Emergency Medicine; 51: 791792.
8. Lang, ES, Wyer, PC, Eskin, B. Executive summary: knowledge translation in emergency medicine: establishing a research agenda and guide map for evidence uptake. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine 2007; 14: 915918.
9. Diner, BM, et al. Graduate medical education and knowledge translation: role models, information pipelines, and practice change thresholds. Academic Emergency Medicine 2007; 14: 10081014.
10. Borror CM (ed.) The Certified Quality Engineer Handbook (3rd edition) Milwaukee, WI: ASQ Quality Press, 2009, pp. 321–332.
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