Assessing the Content, Presentation, and Readability of Dental Informed Consents

Abstract

Informed consents are important aids in helping patients make optimal decisions. Little knowledge exists about the quality of dental informed consents. Fifty-two informed consents used throughout the University of Texas Health Science Center at Houston Dental Branch were evaluated based on the quality of their content, readability, and presentation. Content quality was judged on four basic elements: description of procedure, risk, benefits, and alternatives. Of the clinical consents, 26 percent of forms contained all four of the basic content elements, 48 percent contained three of four elements, 16 percent contained two of four elements, and 10 percent contained one of four elements. Presentation quality was judged on twelve criteria items. The average clinical consent included seven out of twelve presentation items, and the average nonclinical consent included eight out of twelve items. Readability was judged using three standard instruments for rating readability: Flesch Reading Ease, Flesch-Kincaid Grade-Level, and Simple Measure of Gobbledygook (SMOG) grading. Average Flesch-Kincaid Grade-Level was 12.7 (range, 7.4 to 19.1), significantly higher than the recommended ninth grade level (p<.001). The results suggest that many existing dental informed consents may be improved by 1) increasing the comprehensiveness of the content, 2) improving the design and layout, and 3) reducing the readability levels for patient comprehension.

Readability and Content Assessment of Informed Consent Forms for Medical Procedures in Croatia

“…This further indicates that the content of informed consent forms writing is complex and difficult to read for the general population. Our results correspond to results of other authors that performed readability assessment of informed consent forms written in English and Spanish [ 9 , 10 ] or used other readability formulas [ 9 , 10 , 21 ]. High scores raise concerns about whether patients understand informed consent forms they are provided with.…”

“…Assessed Web sites and online materials for specific medical conditions or specific diagnostic or therapeutic interventions contain online medical information of which readability levels exceed recommended reading levels of the average adult population [ 4 – 6 ]. The same pattern is observed with the readability of informed consent forms [ 9 , 10 ].…”

“…The range of health literacy varies form 29% of respondents with limited health literacy in Netherlands to 62% in Bulgaria [ 12 ]. Available studies also confirm that informed consent forms are usually written in such a way that patients frequently do not understand information disclosed to them [ 9 , 10 ]. Our results show that none of assessed informed consent forms were written for the level of primary school below the eighth grade although health information for the general population in Croatia should be written for the level of the fifth or sixth grade [ 16 ].…”

“…Specific content criteria were found to be absent from many informed consent forms [ 9 ]. Our analysis of content of informed consent forms showed omissions in specifying to the patients risks and benefits of alternative treatments and procedures, as well as omissions in informing patients about risks and benefits of not receiving treatment or undergoing procedure.…”

“…SMOG measures difficulty of content by the number of polysyllabic words and score or SMOG grade is presented as the reading grade to indicate the education level required to understand the given text [ 17 ]. SMOG was used because of its high frequency of use in the assessment of the health literature [ 4 – 9 , 18 ], its accuracy and its high correlation with other readability formulas [ 19 ]. For our analysis polysyllabic words were considered to be those words in Croatian language that have four or more syllables [ 16 ], while in the English formula polysyllabic words are those that have three or more syllables [ 17 ].…”