Interactive Ipad-based Patient Education in Breast Reconstruction Planning

Abstract

PURPOSE: In the ambulatory setting, one challenge physicians face is the need to address patient concerns in a brief encounter. This is especially true in consultation visits for breast reconstruction planning, where it is critical that patients are well-informed of options and associated risks. A promising solution is to use innovative educational technologies to provide a framework of understanding for patients just prior to their visit. Studies have shown that information presented in an interactive, multimodal format is better understood and retained than when presented in a static manner. We sought to determine whether an iPad-based interactive education module (iBook) covering breast reconstruction management is effective in patient education. METHODS: We evaluated new patients presenting to our tertiary care plastic surgery outpatient practice for breast reconstruction consultations. Patients received a presurvey, to assess patient perception of knowledge, comfort level talking to physician, and clinic visit anxiety. Patients were then randomly assigned to 2 groups: one group received an iPad (iBook), whereas the other group received the same information in a paper booklet. Patients reviewed the educational module prior to being seen by their physician. After the appointment, they received a postsurvey with the same questions and the “Satisfaction with Surgeon” domain of the BREAST-Q Scale.1 The iBook was developed for iPad using iBooks Author, a Mac OS application, and was written and illustrated by the research team. Using Hemingway editor software, all text was determined to be at a fifth grade reading level. This work was supported by The Plastic Surgery Foundation (PSF) 2019 Breast Reconstruction Awareness (BRA) Fund—Public Awareness Grant. RESULTS: Ten new patients and 1 family member were evaluated in a 2-month period (7 iBook and 4 paper booklet). From the cohort, 82% were between 31 and 60 years old, 70% had a college or graduate degree, and 50% rated their English proficiency at advanced or native. Only patients in the iBook group significantly improved their perceived knowledge score between the presurvey and postsurvey (t = 3.45; P = 0.016). Compared to the paper booklet group, the iBook group had both decreased anxiety (−0.86 versus −0.25; P = 0.7) and an increased surgeon satisfaction score on the BREAST-Q Scale (mean score, 74.1 versus 63.0; P = 0.096). CONCLUSION: The iPad-based educational module significantly improved patient-perceived knowledge. In comparison to the paper booklet group, patients receiving the iBook showed decreased anxiety and increased surgeon satisfaction approaching statistical significance. Interactive educational modalities can be beneficial to a plastic surgery practice by improving patient/family education and satisfaction, as well as decreasing visit anxiety. Providing patients and families with preliminary information can help the visit run more effectively and may help manage patient expectations. Implementation of iBooks to augment patient education should be investigated in other plastic surgery patients, other medical specialties, and different languages. Additional research with a larger cohort will be helpful in improving significance and generalizability. REFERENCE: 1. Pusic AL, Klassen AF, Scott AM, et al. Development of a new patient-reported outcome measure for breast surgery: The BREAST-Q. Plast Reconstr Surg. 2009;124:345–353.