Are patient information leaflets contributing to informed consent for cataract surgery?

Abstract

Aim: To assess, against a checklist of specific areas of required information and using standard published criteria, to what extent leaflets given before cataract surgery provided patients with enough information to give adequately informed consent. Method: Twelve ophthalmology departments in the West Midlands region were asked to submit the cataract information leaflets given to their patients at the preoperative assessment for analysis. Using criteria published by the General Medical Council, British Medical Association, and Medical Defence Union the leaflets were assessed for their contribution to informed consent for patients considering cataract surgery. Leaflets were scored according to the information they provided on: diagnosis, prognosis, treatment options, costs to the patient, details about the procedure, its purpose, likely benefits, how to prepare for it, what to expect during and after the operation, and the common as well as serious complications that may occur. The readability of the information was also assessed. Results: All the units' leaflets provided information on diagnosis, the lifestyle changes required postoperatively, and cost involved to the patient. Only five units had leaflets that mentioned the risks involved in cataract surgery. The other areas of information were covered by 50-75% of the leaflets. Fifty per cent of the leaflets included a diagram. The average SMOG readability score was high. Conclusion: Although present cataract information leaflets make some contribution to the process of informed consent, most do not address important areas outlined by the General Medical Council. Many of the areas of information that are required for informed consent could easily be covered, and should be borne in mind when designing patient information leaflets. Resources are available on the internet including toolkits, guides, and means of assessment for the production of patient information leaflets.

Informed consent for cataract surgery: Patient understanding of verbal, written, and videotaped information

“…The recommended level of readability for an informational brochure is grade 5 or lower; however, most centers are currently using grade 8 or higher. 6 This study suggests the benefit of second-grade over eighth-grade readability for optimum recall and understanding.…”

Designing patient‐focused information: An opportunity for communicating anatomically related information

“…Information leaflets were adopted as they are important in highlighting various subject topics to patient groups and should explain in simple terms the basis of specific healthcare issues. Patient leaflets/fact sheets are still one of the most widely used methods of providing information to patients (Meridith et al, 1995) and as a medium allow patients to digest information at their own pace and without immediate pressure (Brown et al, 2004). They enable patients to pick up accessible information, particularly useful for those without internet access.…”

Ophthalmic residents' surgical training: a study of patient perspective and attitudes in a teaching hospital in India

“…6 Many authors have discussed the best practices for eliciting informed consent through information leaflets, videos, personal interactions and generic proforma. [7][8][9][10][11] However, the more contentious issue of disclosure and discussion of resident training in consent procedures has not achieved much attention, as many surgeons feel that since cataract surgery is an elective surgical procedure, detailed communication with the patients at the time of eliciting informed consent regarding the need and extent of resident participation in their care and the training objectives of the institution may lead the patient to refuse treatment and seek care elsewhere where resident training is not the mandate. They suggest evoking altruistic response from the patient regarding the need for surgical training in society without discussing specific details.…”