Animated narratives in a digital platform

The Department of Urology at Herlev and Gentofte University Hospital (HGH) is the largest in northern Europe. In 2017, 4,244 Danish men were diagnosed with prostate cancer and approximate 220 patients  underwent radical prostatectomy at our Department of Urology.

In Denmark, patients receive their cancer treatment no more than 10 days after diagnosis (1). The system must be efficient and productive and therefore our care is based on the concept of enhanced recovery after surgery (ERAS). ERAS is a multimodal approach to control postoperative pathophysiology and rehabilitation and one of the key components is preoperative information. A very important task for the nurses is to make sure that the patient and his relatives are well informed and can take part in the postoperative rehabilitation (2). However, information to patients recently diagnosed with cancer continues to represent a major challenge.

The nurse often needs to prioritise the information given to the patients. In the outpatient clinic at the Department of Urology HGH 25% of patients claim that they do not receive the information they need about their disease and treatment, or only receive part of it (3). Another study of patients undergoing breast cancer surgery based on ERAS showed that only 18% of the patients had read the written information given to them and they were generally not satisfied with the level of information (4).

My Treatment platform
As nurses we continually discuss how to improve care and stimulate new developments. In the beginning of 2018 My Treatment was presented to all clinical nurse specialists and the head of the department. The initiative was discussed and approved, and the department decided to continue the collaboration.

My Treatment is a concept develop by Visikon, a research-based company specialising in audio-visual communication. My Treatment is a digital platform developed for patients facing a hospital treatment procedure. The platform is developed in close cooperation with the clinical experts at the hospital and is based on the hospital’s own written information (5). By conducting studies Visikon has documented that animation video creates a high degree of identification that may work to reduce pre-surgical anxiety (6).

Several studies show that animated narratives can help reduce patient anxiety (5,6).

From written information to animated narratives
The process began with a review and update of the written patient information done by the department’s own clinical experts, both nurses and doctors. It was a good opportunity to ensure that all the material was updated and the process was characterised by several good clinical discussions regarding evidence-based nursing.

A nurse representative from Visikon came to our department and interviewed our clinical experts of both the inpatient and outpatient clinics. Then an illustrator observed a patient from the time of diagnosis until surgery. Based on the review of our patient information, the interviews and the observations, animated narratives were drafted, speech was added and everything was placed on a digital platform called My Treatment.

The animated narratives were reviewed by our clinical experts and final corrections were done before they were presented to the rest of the department. My treatment was implemented and introduced to patients undergoing radical prostatectomy on 1 December 2018.

The content of My Treatment
The digital platform contains a sequence of 17 animated narratives which prepares the patient and his relatives by describing what happens before, during and after the operation. This includes the psychological reactions to the diagnosis, the importance of mobilisation and nutrition both before and after radical prostatectomy as well as managing pain and constipation after radical prostatectomy. The animated narratives introduce the patient to the care of the urinary catheter at home, when to contact the hospital with complications and the psychological and sexual rehabilitation.

The animated narratives are supported by an interactive diary, symptom guides, frequently asked questions and our department’s own written information material.

Further investigation
After introducing My Treatment, the nurses see better educated patients, both at the outpatient clinic and at the bed unit. This makes the nurses’ interaction with the patient much easier. The nurses use the animated narratives as a guide during day-to-day care in the pre- and postoperative programme and as a supplement during the talk about discharge. The feedback is also positive from the patients. They find My treatment easy to use and they feel well informed.

While implementing My Treatment, the department has initiated a study to identify the effect of the digital platform, and a knowledge questionnaire was constructed in collaboration with Visikon. The questionnaires were handed out to patients 3 months before the implementation and 3 months after. Among other things we hope to clarify the quality of the preoperative information and the information about discharge. We expect the results to be ready by the end of 2019 after which they will be published.

References
1. sst.dk
2. Sygeplejersken 2006; (17) 42-48. Sygeplejefaglige artikler)
3. https://patientoplevelser.dk/sites/patientoplevelser.dk/files/_zip_/982/field_zipfiler_2/1/herlev%20og%20gentofte%20 hospital/Urologisk%20afdeling%20(HEH)/2.%20AMB%20Tabelrapport%202018%20(Urologisk%20afdeling%20(HEH)).pdf
4. Rud K, Egerod I, Brodersen J. Patient experiences of fast-track breast cancer surgery. Klinisk Sygepleje, [s. l.], v. 28, n. 1, p. 46–62, 2014.
5. https://www.visikon.com/
6. Høybye M et al. Producing patient-avatar identification in animation video information on spinal anesthesia by different narrative strategies. Health Informatics Journal. 23 dec. 2014. 1460-4582

• Dennis Michael Hansen, Clinical Nurse Specialist, Herlev and Gentofte Hospital, Copenhagen (DK), Dennis.Michael.Hansen@regionh.dk
• Heidi Andersen, RN, Herlev and Gentofte Hospital, Dept. of Urology, Copenhagen (DK), heidi.andersen@regionh.dk