Human Voice vs AI-Cloned Voice Audio Added to Written Consent Before Ureteroscopy or Retrograde Intrarenal Surgery (AUDIO-CONSENT) (AUDIO-CONSENT)
Effect of Adding a Urologist's Recorded Voice or an AI Clone of the Same Voice to Written Informed Consent on Knowledge, Anxiety, and Satisfaction in Patients Scheduled for Ureteroscopy or Retrograde Intrarenal Surgery: A Multicenter, Three-Arm Randomized Controlled Trial
Before kidney stone surgery with a flexible or semirigid ureteroscope, patients must read and sign a written consent form, but many patients find these forms long and hard to understand. This study tests whether listening to an audio recording of the same consent form, in addition to the usual written form and the surgeon's explanation, helps patients understand the operation better. It also asks whether it matters if the recording is read by a real urologist or produced by artificial intelligence (AI) from a clone of that same urologist's voice.
Adults scheduled for their first ureteroscopy or retrograde intrarenal surgery at three hospitals in Turkey will be randomly assigned to one of three groups: (A) standard written consent only, (B) standard consent plus an audio recording read by a urologist, or (C) standard consent plus the same text produced by an AI-cloned version of the same urologist's voice. All three groups receive exactly the same information, word for word; only the way it is delivered differs. Patients in group C are told that the voice was produced by AI.
The main outcome is a 10-question knowledge test on the content of the consent form, taken immediately after the consent process. Anxiety (State-Trait Anxiety Inventory) and satisfaction are also measured on the same day. No forms are completed on the day of surgery.
Visão geral do estudo
Status
Descrição detalhada
Design: multicenter, prospective, parallel-group, three-arm (1:1:1) randomized controlled trial with outcome-assessor and analyst blinding.
Stimuli: The same unified URS/RIRS consent text is used in all arms. Arm B uses a single studio recording read by one urologist (identical at all centers; not the patients' own surgeon). Arm C uses a voice clone of the same urologist generated with Resemble.ai from a separate reference recording (≥5 min, different text), rendered once and frozen (no live AI calls). Both recordings were loudness-matched (-24.0 LUFS), mono, 48 kHz, AAC; duration 716.8 s vs 708.4 s (1.2% difference). Recordings are presented after the standard written consent process and physician explanation are completed, on a tablet with headphones; patients may replay them (replay count recorded) and may ask the physician questions in every arm. Arms B and C are introduced with structurally parallel sentences ("read by a urologist" vs "generated with AI from a urologist's voice").
Randomization: computer-generated, stratified by center (3) and education level (middle school or less / high school or higher), 6 strata, permuted blocks of varying size (block sizes not disclosed to site staff); allocation concealment by sequentially numbered, sealed, opaque envelopes; the person opening envelopes differs from the outcome scorer. Knowledge tests are scored by an assessor blinded to arm; the dataset is transferred to the statistician with masked arm labels.
Hypotheses (fixed-sequence testing, two-sided α=0.05): H1 knowledge score arm C > arm A; H2 arm B > arm A (tested only if H1 is significant); H3 arm C vs arm B - descriptive only, adjusted mean difference with 95% CI compared against a pre-specified reference range of ±1.0 point; no equivalence or non-inferiority claim will be made.
Sample size: to detect a 1.0-point difference (SD 2.0, d=0.50) with 85% power, 72 analyzable patients per arm; 80 per arm (240 total) allowing 10% loss. A blinded sample-size re-estimation (pooled SD, arm labels not revealed) is performed once after 120 patients; if pooled SD >2.3 the sample size is recalculated with the same effect, α and power.
Analysis: ANCOVA for post-consent knowledge score with arm, education, procedure, age and center; secondary ANCOVA for post-consent STAI-S (STAI-S2) adjusted for pre-consent STAI-S (STAI-S1), STAI-T, sex, education, procedure and center. Pre-specified supportive analysis: arm A vs pooled audio arms (B+C). Exploratory: education × arm interaction; physician (consenting doctor) variance. Knowledge-test psychometrics (KR-20, item difficulty, discrimination) are reported from trial data. Reporting follows CONSORT.
Analysis set: the primary analysis is performed in the modified intention-to-treat (mITT) population - all randomized patients analyzed in their allocated arm who have a measured primary outcome. If missing primary outcome data exceed 5%, a sensitivity analysis using multiple imputation is performed; a per-protocol analysis is also reported as sensitivity analysis.
Tipo de estudo
Inscrição (Estimado)
Estágio
- Não aplicável
Contactos e Locais
Contato de estudo
- Nome: Ahmet Emre Yildiz, MD
- Número de telefone: +90 535 312 98 32
- E-mail: aemreyildiz@gmail.com
Locais de estudo
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Aydın
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Aydin, Aydın, Turquia (Türkiye)
- Recrutamento
- Aydin Adnan Menderes University, Department of Urology
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Investigador principal:
- Cagatay Ozsoy, MD
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Aydin, Aydın, Turquia (Türkiye)
- Recrutamento
- Aydin City Hospital, Department of Urology
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Investigador principal:
- Ahmet Emre Yildiz, MD
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Kütahya
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Kütahya, Kütahya, Turquia (Türkiye)
- Recrutamento
- Kutahya Health Sciences University, Department of Urology
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Investigador principal:
- Seref Coser, MD
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Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
Aceita Voluntários Saudáveis
Gêneros Elegíveis para o Estudo
Descrição
Inclusion Criteria:
- Age 18 years or older
- Scheduled for elective ureteroscopy (URS) or retrograde intrarenal surgery (RIRS)
- Able to read, understand and communicate verbally in Turkish
- Provides written informed consent to participate in the study
Exclusion Criteria:
- Hearing or visual impairment preventing use of the study materials
- Confusion, dementia, psychosis or any other condition affecting capacity to consent
- Emergency surgery
- Previous URS or RIRS
- Current psychiatric treatment or use of anxiolytics
- Health-care professional
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Pesquisa de serviços de saúde
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Solteiro
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
|
Comparador Ativo: A: Written consent (standard care)
Standard care: the unified written consent form plus the physician's usual verbal explanation. No audio recording. |
The institution's unified written informed consent form for ureteroscopy and retrograde intrarenal surgery, read and signed by the patient, together with the physician's usual verbal explanation. Delivered identically in all three arms. |
|
Experimental: B: Written consent + urologist-read audio
Standard care plus an audio recording of the entire consent text read by a urologist (the same recording at all centers), presented after the standard consent process. |
The institution's unified written informed consent form for ureteroscopy and retrograde intrarenal surgery, read and signed by the patient, together with the physician's usual verbal explanation. Delivered identically in all three arms. An approximately 12-minute audio recording of the complete consent text, read word for word by one urologist (the same recording at all centers; not the patient's own surgeon). Presented after the standard written consent and physician explanation, on a tablet with headphones in the patient's room without companions; the patient may replay it and the number of replays is recorded. Loudness-normalized to -24 LUFS. Introduced to the patient as "a recording of the entire consent form read by a urologist". |
|
Experimental: C: Written consent + AI-cloned voice audio
Standard care plus an audio recording of the same text generated with AI from a voice clone of the same urologist, presented after the standard consent process; patients are told that the voice was generated with AI. |
The institution's unified written informed consent form for ureteroscopy and retrograde intrarenal surgery, read and signed by the patient, together with the physician's usual verbal explanation. Delivered identically in all three arms. The same consent text, generated once with Resemble.ai from a voice clone of the same urologist (reference sample: a separate recording of at least 5 minutes of a different text), frozen before enrollment with no live AI calls. Duration approximately 12 minutes; loudness-matched (-24 LUFS), codec and delivery identical to the human-voice recording, presented after the standard written consent and physician explanation, on a tablet with headphones; replay allowed and counted. Patients are informed that the voice was generated with AI from a urologist's voice. |
O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Post-consent knowledge score
Prazo: Day of consent, immediately after completion of the consent process (before surgery)
|
Score on a 10-item multiple-choice test derived from the consent text (range 0-10; higher scores indicate better knowledge of the procedure, its risks, alternatives and patient responsibilities). Each item is mapped to a specific paragraph of the consent form. Analyzed as a continuous variable. |
Day of consent, immediately after completion of the consent process (before surgery)
|
Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Post-consent state anxiety (STAI-S)
Prazo: Day of consent, immediately after the consent process
|
State-Trait Anxiety Inventory, State form (Turkish version, Öner & Le Compte), range 20-80; higher scores indicate greater anxiety. Measured immediately after the consent process and analyzed adjusted for the pre-consent STAI-S score (measured immediately before the consent process) and STAI-T. |
Day of consent, immediately after the consent process
|
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Patient satisfaction and perceived clarity
Prazo: Day of consent, immediately after the consent process
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Three study-specific 5-point items (perceived clarity of the information, adequacy of the information for decision-making, overall satisfaction with the consent process); each scored 1-5, higher scores indicate better outcomes. Reported item by item; total score (3-15) secondary. Not validated. |
Day of consent, immediately after the consent process
|
|
Perceived naturalness and usefulness of the audio recording (arms B and C)
Prazo: Day of consent, immediately after the consent process
|
Two study-specific 5-point items: naturalness of the voice (1 = not at all natural to 5 = completely natural) and usefulness of receiving the information as audio (1 = not at all to 5 = very much). Higher scores indicate greater perceived naturalness/usefulness. Asked in both audio arms. |
Day of consent, immediately after the consent process
|
|
Acceptability of the AI-generated voice (arm C)
Prazo: Day of consent, immediately after the consent process
|
Single study-specific 5-point item: "Did it bother you that the voice was generated by artificial intelligence?" (1 = not at all to 5 = very much; higher scores indicate lower acceptability). Administered on a separate sheet after the naturalness items have been collected. |
Day of consent, immediately after the consent process
|
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Number of audio replays (arms B and C)
Prazo: Day of consent (during the consent session)
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Number of times the patient chose to replay the audio recording. |
Day of consent (during the consent session)
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Self-reported reading of the written consent form
Prazo: Day of consent, immediately after the consent process
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Single item with four categories: read all of it / read most of it / skimmed it / did not read it. |
Day of consent, immediately after the consent process
|
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Withdrawal from or postponement of the planned procedure
Prazo: From the consent process to the scheduled date of surgery (up to 7 days)
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Number and percentage of patients who decline or postpone the planned surgery after the consent process, and of patients who stop the audio recording before completion. Reported descriptively by arm; not interpreted as an adverse outcome. |
From the consent process to the scheduled date of surgery (up to 7 days)
|
Colaboradores e Investigadores
Patrocinador
Investigadores
- Investigador principal: Ahmet Emre Yildiz, MD, Aydin City Hospital
Publicações e links úteis
Publicações Gerais
- Sun Y, Xu S, Jin H, Han X, Jin K, Zhang Y, Ma X, Wei H, Ma M. Effectiveness of Al-Assisted Patient Health Education Using Voice Cloning and ChatGPT: Prospective Randomized Controlled Trial. J Med Internet Res. 2026 Mar 19;28:e81387. doi: 10.2196/81387.
- Haack M, Fischer ND, Frey L, Sparwasser P, Dotzauer R, Duwe G, Haferkamp A, Borgmann H. Digital informed consent for urological surgery - randomized controlled study comparing multimedia-supported vs. traditional paper-based informed consent concerning satisfaction, anxiety, information gain and time efficiency. Prostate Cancer Prostatic Dis. 2024 Dec;27(4):715-719. doi: 10.1038/s41391-023-00737-4. Epub 2023 Nov 4.
- Goldberger JJ, Kruse J, Kadish AH, Passman R, Bergner DW. Effect of informed consent format on patient anxiety, knowledge, and satisfaction. Am Heart J. 2011 Oct;162(4):780-785.e1. doi: 10.1016/j.ahj.2011.07.006. Epub 2011 Sep 14.
- Glaser J, Nouri S, Fernandez A, Sudore RL, Schillinger D, Klein-Fedyshin M, Schenker Y. Interventions to Improve Patient Comprehension in Informed Consent for Medical and Surgical Procedures: An Updated Systematic Review. Med Decis Making. 2020 Feb;40(2):119-143. doi: 10.1177/0272989X19896348. Epub 2020 Jan 16.
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo (Real)
Conclusão Primária (Estimado)
Conclusão do estudo (Estimado)
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Real)
Atualizações de registro de estudo
Última Atualização Postada (Real)
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
- Doenças urogenitais
- Doenças Urogenitais Masculinas
- Cálculos
- Condições Patológicas, Anatômicas
- Doenças renais
- Doenças Urológicas
- Doenças Urogenitais Femininas
- Doenças urogenitais femininas e complicações na gravidez
- Cálculos urinários
- Doenças ureterais
- Nefrolitíase
- Condições Patológicas, Sinais e Sintomas
- Ureterolitíase
- Cálculos renais
- Cálculos ureterais
- Urolitíase
Outros números de identificação do estudo
- AUDIOCONSENT-URS-2026
- 2026/364 (Outro identificador: Aydin Adnan Menderes University Non-Interventional Clinical Research Ethics Committee (approved 17 Sep 2026))
Plano para dados de participantes individuais (IPD)
Planeja compartilhar dados de participantes individuais (IPD)?
Descrição do plano IPD
Fully anonymized individual participant data underlying the results reported in publications (knowledge test item scores, STAI scores, questionnaire responses and baseline covariates), together with the data dictionary. Direct and indirect identifiers will be removed or aggregated before sharing.
Prazo de Compartilhamento de IPD
Beginning 6 months after publication of the primary results.
Critérios de acesso de compartilhamento IPD
Researchers who submit a methodologically sound proposal to the principal investigator. Data are shared after approval of the proposal, approval by the responsible ethics committee where required, and signing of a data-sharing agreement, in accordance with Turkish personal data protection law (KVKK).
Tipo de informação de suporte de compartilhamento de IPD
- PROTOCOLO DE ESTUDO
- SEIVA
- CIF
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