Bamerni D. et al., 2025: Enhanced consent and patient counselling using virtual reality for patients undergoing shockwave lithotripsy: prospective outcomes from a university teaching hospital.
Dara Bamerni, Loretta Tear, Tanya Davis, Phoebe C J Reynolds, Amelia Pietropaolo, Bhaskar K Somani
World J Urol. 2025 Jul 30;43(1):461. doi: 10.1007/s00345-025-05847-3
Abstract
Objective: To discover the effectiveness of VR in improving patient understanding and enhancing the consent procedure for patients undergoing extracorporeal shockwave lithotripsy (SWL). The primary outcomes measured include patient knowledge, pain perception, and emotional well-being.
Methods: For this prospective study (ERGO: 92019), patients with kidney stone disease (KSD) undergoing SWL were given a VR headset before their treatment. The VR glasses visually explained the SWL process (3 min) and its success and complications through an audio explanation linked to a 3D animation. The content followed the patient information leaflet (PIL) from European and British associations. Participants were provided with three questionnaires that covered pain, anxiety, and patient understanding of SWL via the VR enhanced consent (one questionnaire each).
Results: 100 patients completed all three questionnaires. 68 patients reported an improved understanding of SWL with VR, and the overall improvement in patient understanding was statistically significant (p < 0.001). Participants also found the VR headset significantly more helpful and accessible and felt more confident explaining the procedure. 66 participants preferred VR to current teaching methods, and 81 firmly favoured using VR for future procedures. Findings also demonstrated a positive emotional impact, with participants reporting more positive and fewer negative emotions after VR use.
Conclusion: Our study showed that incorporating VR into the consent process effectively improves patient understanding and experience, with widespread approval. VR improved the psychological well-being of patients undergoing surgical procedures, highlighting the potential for VR to play a significant role in enhancing consent.
This was bound to happen in a visually oriented TikTok society. I'm not sure if the answers reflect all the points suggested in the questionnaire, or if they merely express an unqualified agreement with a video game that had to fit within the given answer options.
What surprised me was that all patients had already previous experience with SWL treatment. In the present study they again “signed the standard consent form for the procedure” and “watched a 3-min animated simulation via the VR headset.” It is not stated in detail in which sequence this was done and how much time for understanding and discussion was offered to the patients. However, it seems that even two standard patient information procedures were obviously inadequate.
The author argue that “Providing a universal device that can be given to all patients pre-procedurally ensures there won’t be any inconsistencies between patients,…” I do not agree to the value of a “universal device”. Our policy was not to use a “universal” commercially available information but to oblige the informing doctor to present, explain and discuss a complete and if necessary updated list of why and how SWL, alternatives pros and cons in an individual person-to-person time-taking session.
See also some references of the paper
3. Sherlock A, Brownie S (2014) Patients’ recollection and understanding of informed consent: a literature review. ANZ J Surg 84(4):207–210
4. Manta CJ, Ortiz J, Moulton BW, Sonnad SS (2021) From the patient perspective, consent forms fall short of providing information to guide decision making. J Patient Saf 17(3):e149–e154
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5. Nedbal C, Somani BK, Juliebø-Jones P, Rogers E, N’Dow J, Ribal M et al (2024) 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 86(5):457–469
Peter Alken