Predictors of Comprehension during Surgical Informed Consent

Aaron S. Fink, Allan V. Prochazka, William G. Henderson, Debra Bartenfeld, Carsie Nyirenda, Alexandra Webb, David H. Berger, Kamal Itani, Thomas Whitehill, James Edwards, Mark Wilson, Cynthia Karsonovich, Patricia Parmelee

    Research output: Contribution to journalArticle

    67 Citations (Scopus)

    Abstract

    Background: Patient comprehension during surgical informed consent remains problematic. Using data from our randomized trial of methods to improve informed consent comprehension, we performed an additional analysis to define independent factors associated with improved patient understanding. Study Design: Patients scheduled for 1 of 4 elective operations (total hip arthroplasty [n = 137], carotid endarterectomy [n = 178], laparoscopic cholecystectomy [n = 179], or radical prostatectomy [n = 81]) at 7 Department of Veterans Affairs (VA) medical centers were enrolled. All informed consent discussions were performed using iMedConsent (Dialog Medical), the VA's computerized informed consent platform. Using a unique module within iMedConsent, we randomized patients to repeat back (RB), requiring correct reiteration of procedure-specific facts, or standard (STD) iMedConsent. Patient comprehension was tested after the informed consent discussion using procedure-specific questionnaires. Time spent completing the informed consent process was measured using time stamps within iMedConsent. Multiple linear regression identified factors independently associated with improved comprehension. Results: We enrolled 575 patients (276 RB, 299 standard); 93% were male, 74% were Caucasian, and 89% had at least a high school education. Independent factors associated with improved comprehension included race (p <0.01), ethnicity (p <0.05), age (p <0.02), operation type (p <0.01), group assignment (± RB; p <0.05), and total consent time (p <0.0001). Patient comprehension was maximized when informed consent took between 15 and 30 minutes. RB's positive impact on patient comprehension was weaker in the analysis including consent time. Conclusions: Comprehension during informed consent discussions may be limited in individuals with potential language difficulty due to ethnicity or education. Total consent time was the strongest predictor of patient comprehension. Affording adequate time for informed consent discussions and using informed consent adjuncts such as RB may enhance comprehension in such individuals.

    Original languageEnglish (US)
    Pages (from-to)919-926
    Number of pages8
    JournalJournal of the American College of Surgeons
    Volume210
    Issue number6
    DOIs
    StatePublished - Jun 2010

    Fingerprint

    Informed Consent
    Education
    Carotid Endarterectomy
    Laparoscopic Cholecystectomy
    Veterans
    Prostatectomy
    Arthroplasty
    Hip
    Linear Models
    Language

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Fink, A. S., Prochazka, A. V., Henderson, W. G., Bartenfeld, D., Nyirenda, C., Webb, A., ... Parmelee, P. (2010). Predictors of Comprehension during Surgical Informed Consent. Journal of the American College of Surgeons, 210(6), 919-926. https://doi.org/10.1016/j.jamcollsurg.2010.02.049

    Predictors of Comprehension during Surgical Informed Consent. / Fink, Aaron S.; Prochazka, Allan V.; Henderson, William G.; Bartenfeld, Debra; Nyirenda, Carsie; Webb, Alexandra; Berger, David H.; Itani, Kamal; Whitehill, Thomas; Edwards, James; Wilson, Mark; Karsonovich, Cynthia; Parmelee, Patricia.

    In: Journal of the American College of Surgeons, Vol. 210, No. 6, 06.2010, p. 919-926.

    Research output: Contribution to journalArticle

    Fink, AS, Prochazka, AV, Henderson, WG, Bartenfeld, D, Nyirenda, C, Webb, A, Berger, DH, Itani, K, Whitehill, T, Edwards, J, Wilson, M, Karsonovich, C & Parmelee, P 2010, 'Predictors of Comprehension during Surgical Informed Consent', Journal of the American College of Surgeons, vol. 210, no. 6, pp. 919-926. https://doi.org/10.1016/j.jamcollsurg.2010.02.049
    Fink AS, Prochazka AV, Henderson WG, Bartenfeld D, Nyirenda C, Webb A et al. Predictors of Comprehension during Surgical Informed Consent. Journal of the American College of Surgeons. 2010 Jun;210(6):919-926. https://doi.org/10.1016/j.jamcollsurg.2010.02.049
    Fink, Aaron S. ; Prochazka, Allan V. ; Henderson, William G. ; Bartenfeld, Debra ; Nyirenda, Carsie ; Webb, Alexandra ; Berger, David H. ; Itani, Kamal ; Whitehill, Thomas ; Edwards, James ; Wilson, Mark ; Karsonovich, Cynthia ; Parmelee, Patricia. / Predictors of Comprehension during Surgical Informed Consent. In: Journal of the American College of Surgeons. 2010 ; Vol. 210, No. 6. pp. 919-926.
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    abstract = "Background: Patient comprehension during surgical informed consent remains problematic. Using data from our randomized trial of methods to improve informed consent comprehension, we performed an additional analysis to define independent factors associated with improved patient understanding. Study Design: Patients scheduled for 1 of 4 elective operations (total hip arthroplasty [n = 137], carotid endarterectomy [n = 178], laparoscopic cholecystectomy [n = 179], or radical prostatectomy [n = 81]) at 7 Department of Veterans Affairs (VA) medical centers were enrolled. All informed consent discussions were performed using iMedConsent (Dialog Medical), the VA's computerized informed consent platform. Using a unique module within iMedConsent, we randomized patients to repeat back (RB), requiring correct reiteration of procedure-specific facts, or standard (STD) iMedConsent. Patient comprehension was tested after the informed consent discussion using procedure-specific questionnaires. Time spent completing the informed consent process was measured using time stamps within iMedConsent. Multiple linear regression identified factors independently associated with improved comprehension. Results: We enrolled 575 patients (276 RB, 299 standard); 93{\%} were male, 74{\%} were Caucasian, and 89{\%} had at least a high school education. Independent factors associated with improved comprehension included race (p <0.01), ethnicity (p <0.05), age (p <0.02), operation type (p <0.01), group assignment (± RB; p <0.05), and total consent time (p <0.0001). Patient comprehension was maximized when informed consent took between 15 and 30 minutes. RB's positive impact on patient comprehension was weaker in the analysis including consent time. Conclusions: Comprehension during informed consent discussions may be limited in individuals with potential language difficulty due to ethnicity or education. Total consent time was the strongest predictor of patient comprehension. Affording adequate time for informed consent discussions and using informed consent adjuncts such as RB may enhance comprehension in such individuals.",
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    AU - Prochazka, Allan V.

    AU - Henderson, William G.

    AU - Bartenfeld, Debra

    AU - Nyirenda, Carsie

    AU - Webb, Alexandra

    AU - Berger, David H.

    AU - Itani, Kamal

    AU - Whitehill, Thomas

    AU - Edwards, James

    AU - Wilson, Mark

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