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Real-Time Captioning for Improving Informed Consent: Patient and Physician Benefits
  1. Brent Spehar, PhD*,
  2. Nancy Tye-Murray, PhD*,
  3. Joel Myerson, PhD and
  4. David J. Murray, MD
  1. From the Departments of *Otolaryngology, †Psychology, and ‡Anesthesiology, Washington University School of Medicine, St Louis, MO
  1. Address correspondence to: David J. Murray, MD, Department of Anesthesiology, Washington University School of Medicine, 5S 31, One Children’s Place, St Louis, MO 63110 (e-mail: murrayd{at}


Background and Objectives New methods are needed to improve physicians’ skill in communicating information and to enhance patients’ ability to recall that information. We evaluated a real-time speech-to-text captioning system that simultaneously provided a speech-to-text record for both patient and anesthesiologist. The goals of the study were to assess hearing-impaired patients’ recall of an informed consent discussion about regional anesthesia using real-time captioning and to determine whether the physicians found the system useful for monitoring their own performance.

Methods We recorded 2 simulated informed consent encounters with hearing-impaired older adults, in which physicians described regional anesthetic procedures. The conversations were conducted with and without real-time captioning. Subsequently, the patient participants, who wore their hearing aids throughout, were tested on the material presented, and video recordings of the encounters were analyzed to determine how effectively physicians communicated with and without the captioning system.

Results The anesthesiology residents provided similar information to the patient participants regardless of whether the real-time captioning system was used. Although the patients retained relatively few details regardless of the informed consent discussion, they could recall significantly more of the key points when provided with real-time captioning.

Conclusions Real-time speech-to-text captioning improved recall in hearing-impaired patients and proved useful for determining the information provided during an informed consent encounter. Real-time speech-to-text captioning could provide a method for assessing physicians’ communication that could be used both for self-assessment and as an evaluative approach to training communication skills in practice settings.

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  • The authors declare no conflict of interest.

    This research was supported by grant AHRQ: R18 HS022265-01 to D.J.M. and grant 81296 from The Barnes-Jewish Hospital Foundation and the Washington University Institute of Clinical and Translational Sciences to N.T.-M.