eP287 - A Picture Is Worth a Thousand Words: Graphic Narrative to Supplement Consent for Low Anterior Resection

Purpose/Background: Surgical patients are in high need of treatment-related knowledge, and this is especially true for cancer patients. Patients with rectal cancer require complex, quality-of-life altering treatments, and there is evidence that their information needs are not routinely met. One challenge is ensuring that material provided to patients regarding their treatment is comprehensible regardless of health literacy. This study utilizes a graphic narrative – a comic – to supplement consent for low anterior resection.Methods/Interventions: In this single centre, randomized feasibility trial, 40 English-speaking patients age 18+ undergoing elective low anterior resection for rectal cancer will be recruited. Spielberger state-trait anxiety index and demographic details are collected before 1:1 randomized with a permeated block design. All patients receive standard hospital-based information booklets, while those randomized to the comic arm also receive the comic. Anxiety index and patient satisfaction scores are collected in preop holding and at the time of discharge. Patient satisfaction as well as exposure-based questionnaires are performed at routine 6-week follow-ups.Results/Outcomes: To date, 5 patients have completed the control arm and 8 patients have completed the comic arm. Baseline (pre-randomization) anxiety scores were 61.6 +/- 9.2 in the control arm and 78.5+/-20.1 in the comic arm. In preop holding, patients in both control and comic arms demonstrated higher levels of anxiety (increase in scores by 1.2 and 1.4 points, respectively), and at discharge, showed decrease in anxiety scores (1.6 and 2.4 points, respectively). In preop holding, 100% of patients in the comic arm and 60% in the control arm said that the quality of information they received preop was good or excellent; 40% in the control arm said information they received was fair or poor. All patients in both arms agreed they were adequately prepared for surgery, however, 75% of patients in the comic arm strongly agreed they could visualize steps of their surgical journey; only 40% in the control arm said the same. All patients who received the comic preoperatively thought it was very helpful and believed it reduced anxiety and stress during the surgery journey, and all patients who did not receive the comic believed it would have been very helpful.Conclusion/

Discussion: The addition of a graphic narrative to supplement consent for patients undergoing low anterior resection demonstrated trends toward reduced anxiety at the time of discharge. Standardized questionnaires suggest improved patient satisfaction and preparedness for surgery, and all patients found the graphic narrative helpful. Future directions include translating the graphic to transcend language barriers. In all, this modality may have utility in improving patient understanding and expectations.Panels from "Low anterior resection at St. Paul's Hospital: a graphic narrative"There are 42 panels is the graphic narrative depicting the surgical journey for a patient. These include what patients can expect at a pre-anesthetic visit, when arriving for surgery, in the operating room, recovery room and on the ward. It summarizes the need for ileostomy, risks of complications, and when to contact your surgeon. In all, the goal is to provide meaningful information, written at a grade 6 level, so that patients have reasonable expectations and a sense of familiarity during the surgical portion of their treatment.