Concise informed consent information optimizes patient understanding

This randomized prospective study published in January in the Journal of Cataract & Refractive Surgery demonstrates that concise informed consent information at lower reading grade levels and videotaped information optimize patient understanding of cataract surgery’s benefits, risks and alternative treatments. The authors conclude that better patient understanding could decrease the risk for malpractice cases.

Subjects were 100 patients at the Veterans Affairs Boston Healthcare System who were eligible for cataract surgery. The subjects were randomized into one of four groups for receiving informed consent information: conventional verbal information, conventional verbal information plus second-grade reading level brochure, conventional verbal information plus eighth-grade reading level brochure, and conventional verbal information plus the American Academy of Ophthalmology DVD, “Understanding Cataract Surgery: Patient Education DVD Featuring an Aid to Informed Consent.” After the informed consent process, patients responded to a 12-item questionnaire discussing the surgical procedure, its benefits, its foreseeable and unforeseeable risks, and the alternatives to cataract surgery.

Patients who received conventional verbal information plus a second-grade level brochure (mean score 10.8 ± 1.29 [SD]) and those provided with the verbal information and the DVD (mean score 10.56 ± 1.44) scored significantly higher than patients given verbal information only (mean score 7.68 ± 2.80) or verbal information plus an eighth-grade level brochure (mean score 9.08 ± 1.60). Previous cataract surgery and education level did not significantly influence recall of the informed-consent process.

The authors say that reading brochures in the examination room immediately after verbal consent allowed patients to process information at their own individual pace and greatly improved their short-term retention. The study’s results also suggest an advantage of text written at a second-grade versus eighth-grade reading level for optimizing recall and understanding.

They say that adequate informed consent is imperative to a patient’s overall feeling of success with any procedure. With increased focus by the surgeon on the informed consent process and simplified written information sheets or video, patients may be more willing to defer elective cataract surgery. This would decrease unnecessary surgery and liability. Although the development and use of these tools would require more effort, the authors conclude that the cost benefit would be enormous.