Surgery for Apical Prolapse: A Whiteboard Animation Patient Education Video

Objectives: To create a patient-centered whiteboard animation video to provide education on the basic anatomy of the pelvic floor, approach to surgical management of apical prolapse, and the intended outcomes of the surgery.

Methods: We developed a 4-minute patient-centered whiteboard animation video using evidence-based recommendations from the Society of Obstetricians and Gynaecologists of Canada’s (SOGC) best practice clinical guideline on surgical management of apical prolapse. Our video describes the process and intended outcomes of apical prolapse surgery with reference to pelvic floor anatomy.

We implemented strategies of relatable analogy, lay language with non-medical terminology at the grade 8 reading level, simple labelled diagrams, brevity of content, and summary with takeaway messages to maximize viewer engagement. For example, in the form of an analogy at the start of the video, we invited the viewers to imagine the structure of the vagina to be similar to that of a house with a roof, foundation, walls, and support beams. We used labelled diagrams and color schemes to create a parallel between an architect rebuilding the roof of a house and urogynecologist performing apical prolapse surgery. Building upon this analogy, we described the different approaches to apical prolapse surgery including minimally invasive reconstructive surgery, colpocleisis, and the use of sutures vs. mesh material. We described that having only a hysterectomy does not successfully treat prolapse by highlighting that “this is like leaving an open roof to a house with weak walls.” We included evidence-based information from research measuring success at treating “bulge symptoms” in the first five years after surgery.

Our script was reviewed by members of the general public before being finalized. We liaised with a voiceover artist for narration and recording in a professional studio and with a graphic artist to create simple labelled diagrams and drawings. We included a summary with important reminders at the end of the video. We have housed the video on our patient education website via Youtube – www.bepelvichealthaware.ca.

Clinical Relevance: Pelvic organ prolapse is detected in 50% of patients on examination, although 3-6% of patients will report symptoms – most commonly a sensation of vaginal bulging. Apical prolapse is the descent of the uterus, cervix, and/or vaginal vault. The lifetime risk of requiring prolapse surgery is 11.1-19%. However, surgical treatment involves variable success rates, risk of recurrence, and complications. Evidence-based and well-constructed patient education materials are crucial to support patient counselling, decrease misinformation, and improve patient-physician engagement.

Multimedia patient education materials involve a combination of images, voice, and animation and have been shown to improve knowledge retention, recall, and viewer engagement and satisfaction compared to other formats. Whiteboard animation videos, in particular, are an effective and novel method for conveying complex health information using real-time hand-drawn illustrations with accompanying narration.