ChatGPT's role in alleviating anxiety in total knee arthroplasty consent process: a randomized controlled trial pilot study

Abstract

Background: Recent advancements in artificial intelligence (AI) like ChatGPT have expanded possibilities for patient education, yet its impact on perioperative anxiety in total knee arthroplasty (TKA) patients remains unexplored.

Methods: In this single-blind, randomized controlled pilot study from April to July 2023, 60 patients were randomly allocated using sealed envelopes to either ChatGPT-assisted or traditional surgeon-led informed consent groups. In the ChatGPT group, physicians used ChatGPT 4.0 to provide standardized, comprehensive responses to patient queries during the consent process, while maintaining their role in interpreting and contextualizing the information. Outcomes were measured using Hospital Anxiety and Depression Scales (HADS), Perioperative Apprehension Scale-7 (PAS-7), Visual Analogue Scales for Anxiety and Pain (VAS-A, VAS-P), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and satisfaction questionnaires.

Results: Of 55 patients completing the study, the ChatGPT group showed significantly lower anxiety scores after informed consent (HADS-A: 10.48 ± 3.84 vs 12.75 ± 4.12, P = .04, Power = .67; PAS-7: 12.44 ± 3.70 vs 14.64 ± 2.11, P = .01, Power = .85; VAS-A: 5.40 ± 1.89 vs 6.71 ± 2.27, P = .02, Power = .75) and on the fifth postoperative day (HADS-A: 8.33 ± 3.20 vs 10.71 ± 3.83, P = .01, Power = .79; VAS-A: 3.41 ± 1.58 vs 4.64 ± 1.70, P = .008, Power = .85). The ChatGPT group also reported higher satisfaction with preoperative education (4.22 ± 0.51 vs 3.43 ± 0.84, P <.001, Power = .99) and overall hospitalization experience (4.11 ± 0.65 vs 3.46 ± 0.69, P = .001, Power = .97). No significant differences were found in depression scores, knee function, or pain levels.

Conclusions: ChatGPT-assisted informed consent effectively reduced perioperative anxiety and improved patient satisfaction in TKA patients. While these preliminary findings are promising, larger studies are needed to validate these results and explore broader applications of AI in preoperative patient education.

Figure 1.

Enhanced and expanded flowchart, based on CONSORT 2010, depicting the entire investigation process. TKA: total knee arthroplasty; HADS-A: hospital anxiety and depression scales for anxiety; HADS-D: hospital anxiety and depression scales for depression; PAS-7: perioperative apprehension scale-7; VAS-A: visual analogue scale for Anxiety; WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index; VAS-P: visual analogue scale for pain; SIOPSQs: single-item overall patient satisfaction questionnaires.

Figure 2.

Preoperative informed consent process. (A, B) Two examples of ChatGPT4.0 (Chinese version) responding to patient questions; (C) Patients in the ChatGPT group receiving preoperative informed consent; (D) Patients in the control group receiving preoperative informed consent.

Figure 3.

Comparison of assessment scores administered at various times to the ChatGPT group and control group. (A) HADS-D scores; (B) HADS-A scores; (C) PAS-7 scores; (D) VAS-A scores; (E) WOMAC scores; (F) VAS-P scores. HADS-A: hospital anxiety and depression scales for anxiety; HADS-D: hospital anxiety and depression scales for depression; PAS-7: perioperative apprehension scale-7; VAS-A: visual analogue scale for Anxiety; WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index; VAS-P: visual analogue scale for pain.

Figure 4.

Distribution and comparison of overall hospitalization satisfaction and educational satisfaction ratings. (A, B) Comparison and distribution of educational satisfaction scores between the ChatGPT group and the control group; (C, D) Comparison and distribution of hospitalization satisfaction scores between the ChatGPT group and the control group.