Video-Aided Informed Consent Enhances Patient Education in Gastric Cancer Surgery

Video aids viewed before an in-person consultation shortened informed consent discussions and were associated with no cases of high decisional conflict among patients undergoing gastrectomy for gastric cancer, according to results from a randomized trial (UMIN000056846) published in World Journal of Gastrointestinal Surgery and announced in a news release from Fujita Health University.^1,2 The difference in mean decisional conflict scores, the primary end point, did not reach statistical significance.

What did the trial show for decisional conflict and consultation time?

Among 60 patients, mean decisional conflict scale (DCS) scores after the in-person consultation were 13.5 (95% CI, 8.5-18.6) with pre-consultation video vs 20.5 (95% CI, 15.4-25.6) with standard consent (mean difference, 7.0; 95% CI, –0.2 to 14.2; P = .056). The DCS is a 16-item questionnaire scored from 0 to 100, with higher scores indicating greater conflict.

For secondary end points, no patient in the video group had high decisional conflict (DCS of 37.5 or higher) vs 6 of 30 patients (20%) in the standard group (risk ratio, 0.08; P = .024; number needed to treat, 5). Mean duration of in-person consent time was 22.4 minutes (95% CI, 18.8-26.0) vs 35.9 minutes (95% CI, 32.3-39.5), respectively, for a mean difference of 13.5 minutes (95% CI, 8.4-18.6; P <.001).

In both groups, the mean DCS scores fell. In the video group, scores decreased from 19.0 (95% CI, 14.3-23.7) after the video to 13.5 (95% CI, 8.5-18.6) after consultation (P = .002). In the standard group, scores decreased from 20.5 (95% CI, 15.4-25.6) to 12.4 (95% CI, 8.0-16.9) after patients viewed the video (P <.001); 2 patients (6.7%) still had high conflict after watching the video aid. Notably, no differences or trends were observed in DCS score when stratified by type of gastrectomy. Between both groups, no significant differences were observed in surgical outcomes.

“Rather than replacing the doctor’s explanation, the video was designed to help patients understand essential information before meeting their doctor,” said Kazumitsu Suzuki, senior assistant professor in the Department of Surgery at Fujita Health University in Toyoake, Japan, in the news release.² “We wanted patients to understand the surgery at their own pace so the consultation could focus more on their questions and concerns, supporting shared decision-making.”

What was the design of the trial?

The single-center, prospective, open-label, parallel-group trial enrolled patients from October 2022 to August 2024. Eligible patients were 20 to 75 years old with clinically diagnosed stage I to III resectable gastric cancer scheduled for curative gastrectomy. Written consent was obtained following a detailed explanation of the study; treatment strategies were explained based on preoperative evaluations, abiding by the Japanese Gastric Cancer Treatment Guidelines, during initial consultation. Exclusions included prior gastric cancer surgery, an American Society of Anesthesiologists physical status of 3 or higher, eligibility for neoadjuvant chemotherapy, psychiatric disorders, cognitive impairment, and inability to use the web-based video platform.

Investigators randomly assigned 30 patients to each group using sealed envelopes. The video group watched about 30 minutes of web-based modules, selected by the attending surgeon for the planned procedure (distal, proximal, or total gastrectomy), before the in-person consultation. The standard group had the consultation first and watched the videos afterward. Five faculty surgeons delivered standardized consultations in both groups.

The primary end point was the between-group difference in DCS scores after consultation. Secondary end points were in-person consultation time and the proportion of patients with high decisional conflict. The sample size assumed an effect size of 0.8, with 80% power and a 2-sided α of .05.

“Patients can watch the videos at home, revisit difficult parts, and share the information with family members before their appointment,” added Suzuki.² “This could help shift the consultation from simply delivering information toward a more meaningful dialogue between patients and healthcare professionals.”

What limitations did the authors note?

The authors noted that standardized surgeon training may have lowered conflict in the standard group, which could explain the nonsignificant primary end point. Baseline decisional conflict was not measured before the first consultation, video engagement was not objectively assessed, and total time spent on consent, including the video, was longer in the video group.

Preoperative counseling with 3D-printed models improved shared decision-making in patients undergoing colorectal cancer surgery in a single-center cluster randomized trial (NCT06625008), an example of counseling aids tested in other gastrointestinal surgeries.³ According to the release, the Fujita videos cannot answer individual questions and are not intended to replace physician conversations.² Future digital tools, potentially including artificial intelligence, could personalize information before appointments.

References

1. Suzuki K, Shibasaki S, Watanabe Y, et al. Impact of video-assisted informed consent on decision conflict and consultation time in gastric cancer surgery. World J Gastrointest Surg. 2026;18(9):123251. doi:10.4240/wjgs.123251
2. Video-assisted informed consent helps reduce decisional conflict in cancer patients. News release. Fujita Health University. November 10, 2026. Accessed November 11, 2026. https://tinyurl.com/h34wr32c
3. Khan A, Sellyn GE, Ali D, et al. Three-dimensional–printed models and shared decision-making: a cluster randomized clinical trial. JAMA Netw Open. 2025;8(6):e2513187. doi:10.1001/jamanetworkopen.2025.13187