Pre-Surgical Informed Consent: Improving Patient Understanding
Typical patient education programs consist of pamphlets given to the patient prior to surgery and verbal instructions the day of surgery. Because ambulatory surgery patients play a critical role in their own care management, preoperative education and patient understanding about the surgical process and what to expect is particularly important.
Simply asking questions such as “Do you understand?” or “Do you have any questions?” and having the patient sign an informed consent may not result in the patient truly understanding aspects of their upcoming surgery. The National Quality Forum (NQF) summarizes the results of multiple studies that show:
- 18% - 45% of patients are unable to recall the major risks of surgery
- Many cannot answer basic questions about the services or procedures they agreed to receive
- 44% do not know the exact nature of their operation
- Most do not read (60 to 69 percent) or understand (60 percent) the information contained in informed consent forms (Implementing a National Voluntary Consensus Standard for Informed Consent: A User’s Guide for Healthcare Professionals. 2005. p.1-2).
The 2001 publication Making Health Care Safer: A Critical Analysis of Patient Safety Practices focuses special attention on 11 practices deserving of widespread implementation. One of these practices is “asking that patients recall and restate what they have been told during the informed consent process” to ensure that patients not only read and hear the informed consent, but more importantly, understand the informed consent. NQF reiterated the importance of this practice in Safe Practices for Better Healthcare, which identifies 30 safe practices; one dedicated to informed consent. The practice states that healthcare professionals should ask patients to “teach back,” in their own words, key information about proposed treatments/procedures for which they are being asked to provide informed consent to ensure understanding.
