Varicose Vein Education and Informed coNsent (VVEIN) Study
- Conditions
- Varicose Veins
- Interventions
- Other: Standard ConsentOther: Digital health education tool (dHET)
- Registration Number
- NCT05261412
- Lead Sponsor
- Royal College of Surgeons, Ireland
- Brief Summary
This is a prospective, single centre, randomised controlled, feasibility study recruiting patients with varicose veins. Patients will be randomised to receive standard (verbal discussion and written information pamphlet) consent or a digital health education tool (dHET). The primary endpoints will be feasibility and practicality of introducing dHET into a busy day surgery practice, secondary endpoints will included knowledge recall of essential information, patient anxiety, patient satisfaction and the time spent in person with the responsible surgeon and number of questions asked prior to signing the consent document.
- Detailed Description
Varicose Veins (VV) affect one-third of the adult population and chronic venous disease (CVD) has a negative effect on quality of life (QoL), which can be significantly improved by treatment.\[1-4\] Chronic venous insufficiency (CVI) can be complicated by venous ulceration in over 3% of patients, and chronic treatment with dressings has been estimated to consume 2% of the health budget. Over the last 15 years, minimally invasive endovenous techniques to treat VV have been introduced and are proven to be cost-effective and safe, particularly when performed under a local anaesthetic in an outpatient setting.\[5\] The American Venous Forum, in 2011, and the National Institute for Health and Care Excellence NICE), in 2013, have recommended endovenous thermal ablation (EVTA) techniques, as the first-line treatments for truncal reflux.\[6,7\]
As doctors, there is a legal requirement and duty of care to ensure patients are enabled to make an informed decision about their treatment, including discussion of the benefits, risks and alternative treatments. This is reflected in the Health Service Executive (HSE) National Consent Policy and Irish Medical Council 'Guide to Professional Conduct and Ethics'. \[8\] A patient centered approach to consent has been firmly established in Ireland since 2000, it reinforces that there is a duty to involve patients in decisions about treatments and to engage in a dialogue that offers comprehensible information. This is in keeping with the fundamental ethical principle of autonomy.\[8\]
Interventions to improve information transfer and comprehension in the consent process \[9\], such as standard Patient Information Leaflets (PIL) report mixed results. Information leaflets used during the process of consent have been shown to increase patient factual recall and satisfaction with the consent process and are considered best practice. \[10-15\] However, even well considered PILs, co-designed with patient or client engagement, do not always cover the less common areas of concern or risk which may be material to an individual patient. \[9\] More rigorous approaches are time and cost intensive, and can adversely impact on the efficiency of healthcare delivery, which limits scalability.
Telemedicine has revolutionised the delivery of care to patients in the modern era of computers, tablets, and smartphones and its use has been rapidly expanded.\[16\] Digital platforms are a novel tool to potentially improve dialogue and communication between doctors and patients. Patients in general have high satisfaction ratings for telemedicine, but certain patient-groups may be less likely to engage or benefit from it on account of disability, technological illiteracy or access.\[16\] The use of novel digital technologies can offer a low cost, accessible and tailored solution.
Thus the rationale for this study is to investigate whether it is feasible and acceptable to deliver a digital health education intervention to patients to supplement the consent process.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 40
- Deemed suitable for EVTA by treating surgeon
- First procedure for superficial venous incompetence
- Full consent
- >18 years
- Proficient in English
- Redo or second procedure for superficial venous incompetence (in same or opposite leg)
- Cognitive impairment or unable to consent
- Not meeting inclusion criteria
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Standard Consent (Control) Standard Consent Standard consent (written patient information leaflet (PIL) + verbal discussion with the responsible surgeon) for EVTA followed by signing of consent. Digital health education tool (dHET) Digital health education tool (dHET) dHET for EVTA + verbal discussion with the responsible surgeon followed by signing of consent.
- Primary Outcome Measures
Name Time Method Retention rate Through study completion, an average of 12 months (Number of patients who consent to participation) minus (number of patients who voluntarily withdraw) divided by (number of subjects who enrol)
Time Immediately post intervention Time (seconds) taken to complete the assigned intervention (and any delays caused as a result)
Eligible participants Through study completion, an average of 12 months Number of eligible participants (meeting inclusion criteria)
Acceptability Through study completion, an average of 12 months Number of patients declining to participate, reasons for declining, number of patients withdrawing consent
Adherence to protocol Through study completion, an average of 12 months Number of patients who adhered to assigned intervention protocol, also includes the proportion of complete data for each outcome measure
Barriers to assigned intervention Through study completion, an average of 12 months Number of patients not randomised due to staffing or time constraints (with reason recorded), technology issues with tablet/dHET/link to knowledge quiz/ internet access
Recruitment rate Through study completion, an average of 12 months Number of participants consenting to participate
- Secondary Outcome Measures
Name Time Method Patient Anxiety Baseline, immediately after intervention, delayed (two week follow up) Anxiety measured with short-form State Trait Anxiety Inventory (STAI-6)
Questions asked Post intervention (day of surgery) Number of questions asked by patients during consent
Time spent face to face with surgeon Post intervention (day of surgery) Time spent during verbal discussion of consent with responsible surgeon (measured in seconds)
Knowledge Baseline, immediately after intervention, delayed (two week follow up) Comprehension test about EVTA using True/False format
Patient Satisfaction Immediately after intervention and delayed (two week follow up) Satisfaction of patients measured with Client satisfaction questionnaire (CSQ-8)
Trial Locations
- Locations (1)
Bon Secours Hospital
🇮🇪Dublin, Ireland