The impact of an interactive multimedia educational platform on patient comprehension and anxiety during fertility treatment: a randomized controlled trial

Abstract

Objective: To assess the impact of an interactive multimedia educational platform and consent process on patient comprehension and anxiety state compared with standard fertility counseling and paper consents in patients undergoing ovulation induction-intrauterine insemination (OI-IUI) or in vitro fertilization (IVF) throughout their first infertility treatment cycle.

Design: Prospective randomized controlled trial.

Setting: A university-affiliated reproductive endocrinology and infertility clinic.

Patients: Patients aged 18-45 years undergoing their first OI-IUI or IVF cycle.

Interventions: An interactive multimedia educational and consent platform (EngagedMD-[EMD]) before and during the first infertility treatment, in addition to standard fertility counseling by the physician and nurse team.

Main outcome measures: Three survey time points: before the start of treatment (T1), at the start of treatment (T2), and at the completion of the treatment cycle (IUI or oocyte retrieval; T3). The main outcome measure was the comprehension score on a 15-question assessment administered at 2 times points (T2 and T3). The anxiety state at all 3 time points was assessed using a modified Spielberger State-Trait Anxiety Inventory score.

Results: Eighty-six patients were included: 21 in the OI-IUI conventional (i.e., standard fertility counseling group) group, 22 in the IVF conventional group, 21 in the OI-IUI EMD group, and 22 in the IVF EMD group. Overall, the average number correct on the 15-question comprehension assessment was significantly higher in the EMD groups than in the conventional groups at T2 (EMD: 13.2 ± 1.8 vs. conventional: 11.7 ± 1.8) but not at T3. For those undergoing IVF, the average number correct was significantly higher at both T2 and T3 in the EMD vs. the conventional group (T2: 14.1 ± 1.3 vs. 12.4 ± 1.8; T3: 14.1 ± 1.7 vs. 12.5 ± 1.5). The average State-Trait Anxiety Inventory scores at each time point were similar between the EMD and conventional groups for both OI-IUI and IVF groups. Age ≤35 years and IVF treatment were significant predictors of increased State-Trait Anxiety Inventory scores.

Conclusions: The addition of an interactive multimedia educational platform significantly improved patient comprehension at the initiation of OI-IUI and IVF cycles for patients undergoing fertility treatment for the first time. Those undergoing IVF with access to EMD had sustained, improved comprehension at the end of their treatment. The supplementation of a multimedia platform did not alter anxiety throughout the treatment. Younger patients undergoing IVF may benefit from increased psychological resources.

Clinical trial registration number: NCT03962257.

Keywords: Multimedia platform; assisted reproductive technology; informed consent; patient comprehension.

FIGURE 1

Patient enrollment consort diagram.

FIGURE 2

Comprehension assessment score by exposure. Average comprehension assessment scores at T2 and T3, by exposure alone or by treatment and exposure. Significance is noted by an asterisk (∗). If not noted, the comparison was not significant. EMD = educational and consent platform (EngagedMD); IUI = intrauterine insemination; IVF = in vitro fertilization; T2 = survey time point at the start of treatment; T3 = survey time point at the completion of the treatment cycle.

FIGURE 3

The STAI state scores by group, by exposure, and by exposure and group. The average STAI scores at T1, T2, and T3, by exposure, by group, and by exposure and group. Significance is noted by an asterisk (∗). If not noted, the comparison was not significant. EMD = educational and consent platform (EngagedMD); IUI = intrauterine insemination; IVF = in vitro fertilization; STAI = State-Trait Anxiety Inventory; T1 = survey time point before the start of treatment; T2 = survey time point at the start of treatment; T3 = survey time point at the completion of the treatment cycle.