Explanation is everything
Medical explanations are intended to support patients in deciding for themselves whether or not to undergo a treatment or procedure. The informed consent discussion conveys precisely how an examination or operation will proceed. The medical benefits and potential risks are discussed. Patients often don’t fully understand what’s being said, can’t take it all in properly at that time and feel overwhelmed. They’re unable to process the facts and data in the time provided. This can lead to patients misunderstanding the benefits of a procedure, refusing it or approaching it with fear.
Study proves the value of comics
Two cardiologists at Charité Hospital in Berlin recently faced this challenge. They wanted to optimise informed consent discussions for patients requiring heart catheterisation. As in the case of many examinations and operations, patients were very often overwhelmed in the informed consent discussion by the complexity of the content.
Professor Verena Stangl and Dr Anna Brand of Charité Hospital therefore investigated2 the value of using an informative comic, in addition to the conventional discussion, with 121 patients prior to heart catheterisation. The 15-page comic was designed and created at Charité. Some patients received the standard informed consent discussion, while others received the informed consent discussion plus the comic. The patients were asked, both before and after the discussion, how severe their anxiety was, how well they understood the procedure and whether they were satisfied with the explanation.
The comic turned out to be a success in all respects: patients who received the illustrated brochure in addition to the informed consent discussion were able to answer an average of almost twelve out of 13 questions correctly about the procedure, its risks and important behavioural rules to be followed after the procedure. After the standard informed consent discussion alone, the number of correct answers was just nine out of 13. In addition, after reading the comic, the participants stated that they were less anxious than before the informed consent discussion.
72% of participants were satisfied with the explanation in the comic and felt they were well pre-pared for the heart catheterisation. After the standard informed consent discussion, only 41% of the patients were satisfied with the explanation.
More time to understand
The investigators concluded that comics make it possible to grasp complex content both verbally and visually, which improves understanding for different types of learners. Another advantage of this form of explanation is that, unlike a discussion or a video, comics allow the individual reader to take as much time as necessary to absorb the content.
Despite these findings, comics have not yet seen much use in informed consent explanations, although international studies are now being conducted on the value of comics for patients with breast cancer3, infertility4 and anorexia nervosa5. The use of visual explanation does seem to be much more widespread in the Anglosphere than, for example, in German-speaking countries. Comics can be useful not only for complex examinations, operations and therapies but also, in particular, for topics that are emotionally difficult. Stories in pictorial form can help link feelings, worries and fears to facts and information much better than a discussion can.
Recommended to try
Might this also be a good idea for your clinical practice? Give it a try by working with a good graphic designer to develop a concept for hard-to-understand medical examinations or operations.
Similes can also assist with the transfer of knowledge. To help you, we’ve put together a checklist of «Practical tips for formulating a “graphic narrative“».
Download
Practical tips for formulating a «graphic narrative».
Read more
German
Prof. Dr. Stangl
Verena Kardiologische Comics.
Charité, 2021
German
ComAn 1
Timos Bunter Traum – Comic für Kinder zur Narkose [Timo’s Colourful Dream – Comic for kids on anaesthesia].
Thieme Verlag, 2019
English
Barry, Linda
Making Comics.
Drawn & Quarterly, 2019
English
Haines, Steve
Pain Is Really Strange.
Singing Dragon, 2015
Sources
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Hüther G. Wir denken sehr gerne in Bildern. Whitepaper Storytelling 05. news aktuell 2017; 9–10.
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Brand A, Gao L, Hamann A, et al. Medical Graphics Narratives to Improve Patient Comprehension and Periprocedural Anxiety Before Coronary Angiography and Percutaneous Coronary Intervention: A Randomized Trial. Ann Intern Med 2019;170(8):579–581.
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Lee TI, Sheu SJ, Chang HC, et al. Developing a Web-Based Comic for Newly Diagnosed Women With Breast Cancer: An Action Re-search Approach. J Med Internet Res. 2019;21(2): doi: 10.2196/10716.
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Venkatesan S, Murali C. Infertility Comics and Graphic Medicine. Perspect Biol Med 2018;61(4):609–621.
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Venkatesan S., Peter AM. Feminine famishment: Graphic medicine and anorexia nervosa. Health 2020;24(5):518–534.
