A picture is worth a thousand words

Brain City Berlin

The Charité-Universitätsmedizin Berlin wants to inform patients with a comic before a heart catheter examination. As part of a study, the cardiologists Prof. Dr. Verena Stangl and Dr. Anna Brand investigated whether the method works. The result: The colourful pictures actually help those affected to prepare for an operation. And they reduce anxiety.

“I feel pressure in my chest,” says the patient, who is lying on the operating table with a somewhat worried expression on his face. “Yes, it can happen,” the surgeon reassures him. “Don’t worry, the feeling will go away in a moment.” Before an operation, patients must be informed about the planned procedure. It is not easy for doctors and experts from other scientific disciplines to communicate scientific terminology and complex content in a way that is generally understandable. The Charité - Universitätsmedizin Berlin is taking a new approach here: a comic on the subject of heart catheter examinations is intended to inform patients about the course of the treatment in a way that is easy to understand. The medical benefits and potential risks of the procedure are also explained in the drawings. Experience shows that the basic principle of an upcoming heart catheter examination is often not fully understood by those affected, despite verbal and written information.

“According to the principle 'A picture is worth a thousand words', we wanted to make it easier for these patients to understand the information provided by means of a visual representation,” explains Prof. Dr. Verena Stangl from the Medical Clinic with a focus on cardiology and angiology at the Campus Charité Mitte. Working as a team with her colleague Dr. Anna Brand, science communicator Alexandra Hamann and illustrator Sophia Martineck, she developed a 15-page picture story that illustrates the most common intervention in cardiology: the cardiac catheter examination and, if necessary, the subsequent implantation of a stent.

The two cardiologists then tested the informative comic as part of a pilot study that has now been published in the journal “Annals of Internal Medicine”. A total of 121 patients at the Charité were informed as usual in a medical consultation using the official information sheet before the heart catheter examination. In addition, they could read the comic. Using questionnaires before and after the interview, the scientists then evaluated how well those affected had understood the procedure, how severe their anxiety was and whether they were satisfied with the information. The comic clearly proved to be helpful.

The result of the pilot study – patients feel well prepared

Patients who had received the illustrated brochure in addition to the oral and written information were able to answer correctly an average of 12 out of 13 questions about the procedure, the risks and important rules of conduct after the intervention.
Patients who were informed about the procedure in the traditional way were only able to answer about 9 out of 13 questions correctly.
Overall, around 72 percent of the participants were satisfied with the comic information and felt well prepared for the heart catheter examination. After the standard information, it was only 41 percent. Respondents also said they were less worried after reading the comic than before the informative talk.

“As we have now been able to show in our pilot study, this comic is suitable for preparing those affected better for the procedure,” says Verena Stangl. Her colleague Anna Brand attributes this primarily to the fact that the patients grasp complex content via a picture story both textually and visually. “In addition, a comic – in contrast to a video – gives the reader as much time to grasp the content as is individually necessary.”

In their study, the two cardiologists were able to prove that medical comics are effective as supplementary informative material in this case. “In the future, we want to investigate whether these positive effects can also be transferred to other medical interventions,” explains Anna Brand. The comic tested in the pilot is soon to be used in the Charité – as supplementary informative material before heart catheter examinations. In this way, patients with heart problems also have something to smile about in the meantime. (vdo)

“Brand A et al., Medical Graphic Narratives to Improve Patient Comprehension and Periprocedural Anxiety Before Coronary Angiography and Percutaneous Coronary Intervention: A Randomized Trial.” Ann Intern Med. 2019 Apr 9. doi: 10.7326/M18-2976