Animation-assisted counseling before fetoscopic laser surgery for twin-to-twin transfusion syndrome: a randomized
Piyatida Thongkloung1, Nisarat Phithakwatchara1, Katika Nawapun1
1Siriraj Fetal Therapy Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Background:
Patients considering fetoscopic laser surgery for twin-to-twin transfusion syndrome must understand complex placental anatomy, treatment alternatives, and maternal and fetal risks, usually deciding on the day of counseling during an acutely stressful pregnancy. To our knowledge, how best to deliver this information has not been evaluated in a randomized trial.
Objective:
This study evaluated whether animation-assisted counseling increased immediate factual knowledge compared with standard counseling and estimated its effects on specialist counseling time, total patient education time, anxiety, and prespecified intervention-related harms.
Study Design:
In this single-center, parallel-group randomized trial at a university fetal therapy center, 44 pregnant patients for whom fetoscopic laser surgery was recommended were assigned 1:1 to a 5-minute 16-second tablet animation followed by individualized specialist discussion or to standard specialist verbal counseling with static images. The prespecified primary outcome was a perfect score on a 10-item knowledge questionnaire completed immediately after counseling. Secondary outcomes included the continuous knowledge score, specialist counseling time, and anxiety. Analyses followed the intention-to-treat principle. Post hoc analyses addressed total patient education time, baseline knowledge, poorly performing questionnaire items, and counselor.
Results:
A perfect score was achieved by 15 of 22 participants (68.2%) after animation-assisted counseling and 7 of 22 (31.8%) after standard counseling (risk difference, 36.4 percentage points; 95% confidence interval, 6.9-58.2; risk ratio, 2.14; 95% confidence interval, 1.09-4.21; P=.016). This estimate was unchanged after excluding the 2 items with negative item-total correlations, and the risk ratio was 1.95 after adjustment for baseline knowledge (small-sample-corrected 95% confidence interval, 0.98-3.89). Mean postcounseling knowledge was 9.50 vs 8.45 (mean difference, 1.05 points; 95% confidence interval, 0.38-1.71; P=.003) and remained higher after baseline adjustment (0.95 points; 95% confidence interval, 0.35-1.56; P=.003). Specialist counseling time was 513 vs 909 seconds (mean difference, -396 seconds; 95% confidence interval, -537 to -255; P<.001), whereas total patient education time including the animation was similar (829 vs 909 seconds; mean difference, -80 seconds; 95% confidence interval, -221 to 61; P=.256). Anxiety findings were inconclusive, and no intervention-related harms occurred.
Conclusion:
Animation-assisted counseling improved immediate factual knowledge at the point of the treatment decision and released specialist counseling time without lengthening patient education. It is best used as a standardized adjunct to individualized dialogue. Whether these gains translate into retained understanding and better decision quality requires multicenter evaluation.
Trial Registration:
Thai Clinical Trials Registry, TCTR20220423001 (https://www.thaiclinicaltrials.org); registered April 23, 2022.
