Patient consent in the modern era: Novel tools and practical considerations in urology

Abstract

Informed consent is a cornerstone of ethically acceptable surgical interventions. Traditional methods primarily rely on verbal explanations by clinicians and, at times, the use of supplementary resources such as information leaflets. In the modern era, novel tools have emerged to facilitate and enhance the consent process. Examples include multimedia, 3D models, virtual and augmented reality, quick response codes, and artificial intelligence technologies such as large language models. This narrative review provides an overview of these aids, discussing their potential advantages and limitations. In addition, the influence of social media on the consent process is explored.

Keywords

Social media / Urology / Consent / Surgery

Acknowledgments

None.

Statement of ethics

Not applicable.

Conflicts of interest statement

PJ is an editorial board member of Current Urology, confirms no involvement in any stage of this article's peer-review process, ensuring unbiased editorial decision-making. This article was accepted after normal external review. The other authors declare that they have no conflits of interest.

Artificial intelligence in the form of ChatGPT has been used to edit parts of the language in this submission.

Funding source

None.

Author contributions

None.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

[1] Burks AC, Keim-Malpass J. Health literacy and IC for clinical trials: A systematic review and implications for nurses. Nursing: Research and Reviews 2019;9:31-40.

[2] Gardiner TM, Gillespie BM, Latimer S, Hewitt J. Exploring healthcare professionals' perspective of the process of obtaining consent for adult patient's having planned surgery: A scoping review. J Clin Nurs 2023; 32(17-18):5779-5792.

[3] Dahlberg J, Dahl V, Forde R, Pedersen R. Lack of IC for surgical procedures by elderly patients with inability to consent: A retrospective chart review from an academic medical center in Norway. Patient Saf Surg 2019;13:1-6.

[4] Lane J, Bhome R, Somani B. Urological litigation trends in the UK National Health Service: An analysis of claims over 20 years. BJU Int 2021; 128(3):361-365.

[5] Mittal A, Kum F, Rice M, Mak Q, Cakir O, Jalil R. An innovative use of quick response codes to provide patients information in urology. J Clin Urol 2024; 17(4):405-411.

[6] Chen H. The impact of Chatbot-aid on promoting self-management of men's health in the post COVID-19 era. ClinicalTrial.gov 2023;1-3.

[7] Scott ER, Singh A, Quinn AM, et al. The use of individualized 3D-printed models on trainee and patient education, and surgical planning for robotic partial nephrectomies. J Robot Surg 2023; 17(2):465-472.

[8] Hameed BMZ, Pietropaolo A, Naik N, et al. Role of three dimensional (3D) printing in endourology: An update from EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group. Front Surg 2022;9:862348.

[9] Nedbal C, Juliebø-Jones P, Rogers E, et al. Improving patient information and enhanced consent in urology: The impact of simulation and multimedia tools. A systematic literature review from the European Association of Urology Patient Office. Eur Urol 2024; 86(5):457-469.

[10] Wake N, Rosenkrantz AB, Huang R, et al. Patient-specific 3D printed and augmented reality kidney and prostate cancer models: Impact on patient education. 3D Print Med 2019;5:4.

[11] Haack M, Fischer ND, Frey L, et al. Digital IC for urological surgery-randomized controlled study comparing multimedia-supported vs. traditional paper-based IC concerning satisfaction, anxiety, information gain and time efficiency. Prostate Cancer Prostatic Dis 2024; 27(4):715-719.

[12] Sullivan GA, Harmon K, Gill-Wiehl GF, et al. Measuring impact of simulation-based IC training on surgical intern's long-term confidence. J Surg Educ 2023; 80(6):884-891.

[13] Connor MJ, Miah S, Edison MA, et al. Clinical, fiscal and environmental benefits of a specialist-led virtual ureteric colic clinic: A prospective study. BJU Int 2019; 124(6):1034-1039.

[14] Halder GE, White AB, Brown HW, et al. A telehealth intervention to increase patient preparedness for surgery: A randomized trial. Int Urogynecol J 2022; 33(1):85-93.

[15] Sassani JC, Grosse PJ, Kunkle L, Baranski L, Ackenbom MF. Patient preparedness for pelvic organ prolapse surgery: A randomized equivalence trial of preoperative counseling. Female Pelvic Med Reconstr Surg 2021; 27(12):719-725.

[16] Flockton A. Men's experience of virtual simulation to aid patient education for radiation treatment to the prostate. J Med Imaging Radiat Sci 2017; 48(1):S6-S7.

[17] Marquess M, Johnston SP, Williams NL, et al. A pilot study to determine if the use of a virtual reality education module reduces anxiety and increases comprehension in patients receiving radiation therapy. J Radiat Oncol 2017;6:317-322.

[18] Pandrangi VC, Gaston B, Appelbaum NP, Albuquerque FC Jr., Levy MM, Larson RA. The application of virtual reality in patient education. Ann Vasc Surg 2019;59:184-189.

[19] Tzelves L, Talyshinskii A, Nedbal C, et al. Patient perspectives on vasectomy: Findings from a TikTok® content analysis. Int J Impot Res 2024. doi:10.1038/s41443-024-00931-5Epub ahead of print.

[20] Juliebø-Jones P, Tzelves L, Beisland C, Roth I, Somani BK. Patient experiences and perceptions of kidney stone surgery: What lessons can be learned from TikTok? Front Surg 2024;11:1374851.

[21] Ricci G, Gibelli F, Bailo P, Caraffa AM, Nittari G, Sirignano A. Informed consent in paediatric telemedicine: Challenge or opportunity? A scoping review. Healthcare (Basel) 2023; 11(10):1430.

[22] Talyshinskii A, Naik N, Hameed BMZ, Khairley G, Randhawa P, Somani BK. Telemedicine in endourology for patient management and healthcare delivery: Current status and future perspectives. Curr Urol Rep 2024; 25(11):299-310.

[23] Naik N, Hameed BMZ, Nayak SG, et al. Telemedicine and telehealth in urology-What do the ‘patients’ think about it? Front Surg 2022;9:863576.

[24] Hameed BMZ, Somani S, Keller EX, et al. Application of virtual reality, augmented reality, and mixed reality in endourology and urolithiasis: An update by YAU Endourology and Urolithiasis Working Group. Front Surg 2022;9:866946.

[25] Talyshinskii A, Hameed BZ, Zhanbyrbekuly U, et al. Role of virtual reality in improving the spatial perception of the kidney during flexible ureteroscopy: A feasibility study using virtual reality simulators and 3D models. Curr Urol 2024; 18(1):24-29.

[26] Utz C, Degeling M, Fahl S, Schaub F, Holz T. (Un) IC: Studying GDPR consent notices in the field. Proceedings of the 2019 ACM SIGSAC Conference on Computer and Communications Security. 2019. Available at: https://doi.org/10.48550/arXiv.1909.02638. Accessed January 8, 2024.

[27] Decker H, Trang K, Ramirez J, et al. Large language model-based chatbot vs surgeon-generated IC documentation for common procedures. JAMA Netw Open 2023; 6(10):e2336997.

[28] Javid M, Bhandari M, Parameshwari P, Reddiboina M, Prasad S. Evaluation of ChatGPT for patient counseling in kidney stone clinic: A prospective study. J Endourol 2024; 38(4):377-383.

[29] Talyshinskii A, Naik N, Hameed BMZ, Juliebø-Jones P, Somani BK. Potential of AI-driven chatbots in urology: Revolutionizing patient care through artificial intelligence. Curr Urol Rep 2024; 25(1):9-18.

[30] Mirza FN, Tang OY, Connolly ID, et al. Using ChatGPT to facilitate truly informed medical consent. NEJM AI 2024; 1(2):AIcs2300145.

[31] Pompili D, Richa Y, Collins P, Richards H, Hennessey DB. Using artificial intelligence to generate medical literature for urology patients: A comparison of three different large language models. World J Urol 2024; 42(1):455.

[32] Juliebo-Jones P, Gauhar V, Keller EX, et al. Social media and urology: The good, the bad and the ugly. Urologia 2024; 91(4):659-664.

[33] Teoh JYC, Cacciamani GE, Gomez RJ. Social media and misinformation in urology: What can be done? BJU Int 2021; 128(4):397.

[34] Cocci A, Pezzoli M, Lo Re M, et al. Quality of information and appropriateness of ChatGPT outputs for urology patients. Prostate Cancer Prostatic Dis 2024; 27(1):103-108.

[35] Juliebø-Jones P, Emiliani E, Sierra A, et al. Patient perspectives on kidney stone surgery: A content analysis of instagram posts by patients versus surgeons. Eur Urol Open Sci 2023;58:82-86.

[36] Rouprêt M, Morgan TM, Bostrom PJ, et al. European Association of Urology (@Uroweb) recommendations on the appropriate use of social media. Eur Urol 2014; 66(4):628-632.

[37] Borgmann H, Cooperberg M, Murphy D, et al. Online professionalism— 2018 update of European Association of Urology (@Uroweb) recommendations on the appropriate use of social media. Eur Urol 2018; 74(5):644-650.

[38] Juliebø-Jones P, Gauhar V, Talyshinskii A, et al. Sharing surgical images on social media: A snapshot of practices and some reflections for improvement. BJU Int 2025; 135(3):424-425.

[39] Kilic Y, Chauhan D, Avery P, et al. The public's attitude towards doctors' use of twitter and perceived professionalism: An exploratory study. Clin Med (Lond) 2021; 21(5):e475-e479.

[40] Allen JW, Earp BD, Koplin J, Wilkinson D. Consent-GPT: Is it ethical to delegate procedural consent to conversational AI? J Med Ethics 2024; 50(2):77-83.

[41] Smith ED, Savage SK, Andrew EH, et al. Development and implementation of novel chatbot-based genomic research consent. bioRxiv [Preprint] 2023. doi:10.1101/2023.01.23.525221.

[42] Bouhadana D, Nguyen DD, Raizenne B, et al. Evaluating the acceptability of an online patient decision aid for the surgical management of lower urinary tract symptoms secondary to benign prostatic hyperplasia. Can Urol Assoc J 2021; 15(8):247-254.

[43] Gardiner TM, Latimer S, Hewitt J, Gillespie BM. Not just for surgeons: A qualitative exploration of the surgical consent process. Collegian 2024; 31(1):1-9.

[44] Nedbal C, Adithya S, Naik N, et al. Can machine learning correctly predict outcomes of flexible ureteroscopy with laser lithotripsy for kidney stone disease? Results from a large endourology university Centre. Eur Urol Open Sci 2024;64:30-37.