In the United States, the right to determine if medical tests, procedures or treatments are to be conducted is manifest through the process of informed consent. The doctrine of informed consent specifies that competent individuals have the right to make a """"""""right"""""""" or """"""""wrong"""""""" decision so long as the following 3 core criteria are met: (1) relevant medical information has been disclosed in understandable terms, (2) the patient has the mental capacity to make the decision, and (3) the decision is voluntary. The process of obtaining informed consent with a person who has a serious mental illness can be especially difficult. For patients with severe depression, with or without psychotic features, it is unclear how a patient would interpret information that would otherwise be easily understood in the absence of the illness. Insuring informed consent for electro-convulsive therapy (ECT) is particularly problematic. This is a proposal to develop a computer-based interactive video for patients considering ECT as a treatment. It will 1) provide fair and balanced medical information about ECT in an easy to understand television-news documentary format, 2) conduct interactive exercises to explore the patients understanding of treatment options and consequences, and 3) provide an """"""""adaptive learning mode"""""""" for patients who are unable to understand the video presentation. This program will augment the process of informed consent by providing feedback to the clinician regarding the patients' comprehension of the (a) indications for ECT, (b) actual procedure, and (c) risks and benefits. The clinician will ultimately decide if the patient is truly giving informed consent based on their interactions with the patient as well the additional information provided by the interactive computer program. This Phase I proposal will develop the interactive video system for (a) indications for ECT. Feasibility and user satisfaction will be assessed.
