Patients can access information regarding their conditions and treatment options from a variety of sources ranging from public libraries to Internet Web sites, but if physicians provide their patients with preselected educational materials, they can ensure that the information they receive is accurate and helpful, said Jeffrey Orringer, M.D., assistant professor of Dermatology at the University of Michigan.
"The truth is that information on the Internet is highly variable in its validity," Orringer said. "If people are getting information off the Internet, it may run counter to the message we're seeking to deliver."
In a study published in the August issue of the Journal of the American Academy of Dermatology, Orringer reported that providing melanoma patients with an instructional videotape after their diagnosis but prior to their first consultation visit increased their knowledge of their condition and lowered their anxiety and distress.
In a randomized controlled trial conducted between Oct. 12, 2001 and Nov. 22, 2002 at the University of Michigan Multidisciplinary Melanoma Clinic in Ann Arbor, Orringer provided 112 of 217 patients with a video and two sets of questionnaires to measure melanoma knowledge, anxiety and emotional distress levels. The patients were asked to fill out one set before viewing the video and one set afterward.
The other group of patients received the questionnaires but not the video. The first set was filled out before their initial visit to the clinic. They filled out the second set after seeing their doctor, but before leaving the clinic.
Patients receiving the video reported an understanding of melanoma superior to that of patients who received only oral instruction from their doctors. Patients also recorded decreased levels of anxiety and distress after watching the video. Those decreases, however, were even greater in the group that was surveyed after visiting with their doctor.
Specifically, the video group's knowledge scores increased by an average of 8.8 points on a 23-item multiple-choice questionnaire, compared with a 5.1 average increase for the other group.
A 40-item questionnaire was used to measure anxiety and the National Comprehensive Cancer Network's "distress thermometer" was used to measure emotional distress. With both instruments, lower scores were considered more desirable for patients.
The anxiety and emotional distress scores of the video group fell by 3.2 and 0.56 points, respectively. For the nonvideo group, the decreases were much greater, anxiety and emotional distress scores fell by 10.21 and 1.36 points respectively.
"It certainly was very validating to see just how vital the traditional doctor-patient relationship remains to their sense of well being," Orringer said.
He explained how physicians could tailor their messages to suit a particular patient and to address their individual concerns. They can also express sentiments of sympathy and compassion, "which are highly valuable to reassure patients and offer hope, where a video may not be the proper way to convey those messages," Orringer said.
On the other hand, he said the same invariability that limits a video's emotional content also helps contribute to its success as an educational tool. Orringer said videos offer visual elements that printed materials can't duplicate and also can be used for a population with a variety of literacy levels.
The video used in the trial featured professional actors and was developed by a multidisciplinary team of dermatologists, surgeons, oncologists, psychiatrists, nurses, social workers and others. It lasted just under 11 minutes, and Orringer said there was no predetermined time limit and that its length was determined by the "teaching points" the team determined to be important to a patient who had just been diagnosed with melanoma.
Orringer said he envisions more videos being made for other diseases or for patients to view before they undergo certain medical procedures.
"We have every reason to think that the principles of education and stress reduction ought to translate to patients with other conditions," Orringer said. "I would hope that physicians in other specialties would look to this as a starting point to developing tools relative to their own patients."