A New Look at Informed Consent: Recent guidelines prompt patient-centered approach

Cedars-Sinai, for example, recently introduced the Emmi system, which gives physicians an access code to their patients, who can then read online materials or view videos about their condition, procedure and other treatment options. At first, Dr. Hopp’s colleagues reviewed the content and decided against using it, because although they liked the concept, they did not like the ENT portions. Hospital and Emmi staff, however, returned to them a year later and gave them the opportunity to re-write the materials. Dr. Hopp will start using the resultant materials in the coming months.

Providing extra detail can make some physicians uncomfortable. They may worry that they’ll leave something off the list or that a long list of specific risks will scare the patient away from needed treatment. But, Dr. Hopp pointed out, “More detail is better. It’s how you handle it that makes the difference. [More information] makes the patient a participant in their health care. The more they understand about the healing process, the better a patient they are.”

According to a study in the March 2010 issue of Archives of Otolaryngology-Head & Neck Surgery, additional detail may increase recall of the risks of surgery. In the study, conducted at Walter Reed Army Medical Center in Washington, D.C., parents of children scheduled for tonsillectomy or ear tube placement were split into two groups: Parents in one group went through the standard informed consent process and received an informational sheet about the general risks of surgery, while the other group received information that described the risks associated with the specific procedure. In addition, the physicians in the second group were given a checklist of risks to ensure that they covered each one in their discussions with the parents. The group of parents that received the more specific information remembered an average of six out of 10 risks, while the control group remembered an average of 4.44 risks.

But it’s not just the content of the information that affects how the patient receives it—it’s also how that content is presented.

Most patient education materials are written at a high school reading level, and informed consent forms are so vague and full of legalese that they can be difficult for even a college-educated patient to understand. Re-writing those materials so that the average patient, with a fifth or sixth grade reading level, can understand them is a very good step. Dr. Yaremchuk noted that Microsoft Word offers an option to “show readability statistics” in its grammar check, and this is a good way to get an idea of the reading level of in-house documents.