Proper pre-treatment instruction is vital in alleviating anxiety and apprehension about the use of 5-FU cream for treatment of actinic keratoses. Furthermore, this may improve management of diffuse actinic damage and possibly decrease the incidence of squamous cell carcinomas developing from actinic keratoses. In the present study, viewing an educational video prior to treatment did not lead to statistically significant differences in patient satisfaction and treatment completion rates when compared to usual verbal instruction.
Our results show no significant differences between the video and usual verbal instruction group, with regards to the questionnaire responses (Table 1). For example, when asked: “How satisfied are you with the doctors who treated your pre-cancers (actinic keratoses)?” in Q6, 10 of 12 (83%) selected “very satisfied” in the video group, while 18 of 18 (100%) selected “very satisfied” in the usual verbal instruction group. This difference was not found to be statistically significant. Additionally, when asked: “Did you complete your treatment as instructed by your dermatologist?” in Q8, 12 of 12 (100%) missed doses 3 days or less during the treatment period in the video group, whereas 17 of 18 (94%) missed doses 3 days or less in the usual verbal instruction group. Again, this difference was also not found to be statistically significant.
Our findings present a few implications. First of all, the patient educational video may provide the same high level of satisfaction as the usual verbal instruction group, as evidenced by the median Q10 score of 90 out of 100, where 100 represented the highest level of general satisfaction, in both the video and usual verbal instruction group. Given this, one can argue that showing patient education videos as a substitute to usual verbal instruction in the office will yield identical treatment outcomes in the context of a complicated medical regimen as in the case of 5-FU treatment for actinic keratosis. Not only may this yield identical treatment outcomes and patient satisfaction, but the option of employing patient educational media such as video yields increased clinic efficiency and opportunities for a multidisciplinary approach to pre-treatment education, as various members of the care team including nursing staff and medical assistants can play a key role in delivering the media to the patient in the office setting.
Potential limitations to the study are as follows: There is a small sample size and results do not reach statistical significance. Also, the method of MD instruction was not standardized. The video group received an introduction to the concept of 5-FU treatment by the treating MD, which was not standardized or scripted across providers, and multiple MDs were involved in the instruction process for both groups. This introduction was understood to be significantly abbreviated compared to the usual verbal instruction given to the control group. This introduction may be perceived as full MD counseling in members of the video group and leaves the meaning of an introduction to 5-FU up to interpretation by the provider, leading to variation regarding the depth and detail of this treatment introduction. Furthermore, given that the questionnaires were not anonymous as they were performed via telephone with an MD provider, the participants may have felt a desire to please the MD by responding in a generally affirmative manner regarding their level of satisfaction. A fully anonymous modality for feedback might yield more accurate results in a future study.