title: Systematic review and meta-analysis of audio-visual information aids for informed consent for invasive healthcare procedures in clinical practice.
abstract: OBJECTIVE
  To systematically review audio-visual (AV) interventions for promoting informed consent (IC) in clinical practice and to consider the impact of reading age adjustment.
  
  
  METHODS
  Systematic review of randomized controlled trials (RCTs) comparing AV interventions to standard IC in clinical practice. Outcomes included recall (immediate <1 day; intermediate 1-14 days; late >14 days), satisfaction and anxiety. Data were synthesized using random effects meta-analyses. Comparisons were made between studies that did and did not adjust for participant reading age.
  
  
  RESULTS
  Of 11,813 abstracts screened, 29 RCTs were eligible (30 intervention arms). Interventions included videos (n=17), computer programs (n=5), electronic presentations (n=3), compact discs (n=3) and websites (n=2). Meta-analysis showed AV interventions improved immediate recall (standardized mean difference [SMD] 0.64, 95% confidence interval [CI] 0.45-0.85). Results for intermediate and late recall were too heterogeneous to synthesize. AV interventions did not consistently affect either satisfaction or anxiety. Adjusting the reading age of interventions improved immediate recall (reading age interventions: adjusted SMD 1.21, 95%CI 0.81-1.61; non-reading age adjusted SMD 0.51, 95%CI 0.36-0.66).
  
  
  CONCLUSIONS
  AV interventions, especially those adjusted for participant reading age, improve immediate information recall for IC. Practice implications Wider use of AV aids is justified when obtaining IC in clinical practice.
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK. Electronic address: farrelleh@cardiff.ac.uk.
authors.forename: Elinor H
authors.initials: EH
authors.lastname: Farrell
authors.affiliation: Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Whistance
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK.
authors.forename: Katie
authors.initials: K
authors.lastname: Phillips
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Morgan
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK.
authors.forename: Katherine
authors.initials: K
authors.lastname: Savage
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Lewis
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Kelly
authors.affiliation: Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Blazeby
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Kinnersley
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK.
authors.forename: Adrian
authors.initials: A
authors.lastname: Edwards
mesh_terms: D001296:Audiovisual Aids; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000706:statistics & numerical data*; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D013514:Surgical Procedures, Operative
keywords: Audio-visual interventions; Informed consent; Systematic review