Evaluating the Readibility of Informed Consent Forms Available Before Anaesthesia: A Comparative Study

Abstract

Objective: Informed consent forms that are used prior to administering anaesthesia inform patients before any proposed surgical procedure or treatment. They should provide patients with sufficient information about the operation and treatment. Readibility refers to whether it is easy or hard for a reader to read and understand an available text, and this is evaluated via various formulas. The aim of this study was to evaluate the readability of different informed consent forms commonly used in the anaesthesiology departments of different hospitals in our country using different readability formulas. Methods: After obtaining ethics committee approval, the readability of different consent forms used in the anaesthesiology departments of university hospitals (n=15), Ministry of Health (MOH) education and research hospitals (n=15), and public hospitals (n=15) was analysed. Each consent form was displayed electronically in "Microsoft Word" and the number of words contained was counted automatically. The first 100 words on the first page of the forms were evaluated using the Gunning Fog, Flesch-Kincaid and Ateşman readability formulations. The rate of medical terms detected within these 100 words was determined as a percentage (%). Results: Different consent forms obtained from 45 anaesthesia departments were assessed using various readability formulas. According to the Gunning Fog index, the readability of the consent forms obtained from MOH education and research and public hospitals was relatively low. The Flesch-Kincaid index measured very low levels of readability in all institutions. The Ateşman index displayed very low readability levels for the consent forms used in university hospitals, and low levels in other institutions. Conclusion: We conclude that the readability of the anaesthesia informed consent forms is low. The level of education in our country should be considered in the preparation of anaesthesia consent forms. We believe that physicians should pay more attention to this medical and legal issue.

Evaluation of the Readability of Informed Consent Forms Used for Emergency Procedures

“…Even though the education level of the individual is high, it may cause misunderstanding for an individual not used to the medical literature. Thus consent forms should not contain medical terms as much as possible [4].…”

“…Factors influencing readability are the word length, word frequency, multi syllable number, sentence length, ambiguous word number and syllable number. The readability of the sentence decreases as the number of words in a sentence increase [4]. There are many formulas developed for readability analysis [5−8].…”

Is it Necessary to Develop a Series of Rational Standards for Informed Consent?

“…Cümledeki kelimelerin sayısı arttıkça bir cümlenin okunabilirliği de azalmaktadır. 19 Okunabilirlikten kasıt metnin tam olarak anlaşılmasıdır. Anlaşılamayan bir bilgilendirilmiş rıza formunun hastayı özerk kıldığı ve hukuki gereği yerine getirdiği söylenememektedir.…”

“…22 Okunabilirlik testleri metnin anlaşılabilirliği konusunda kesin sonuçlar vermese de metin düzeyi hakkında fikir vermektedirler. 19 Geçerli bir objektif testin yapılmasında da güçlükler bulunmaktadır. Örneğin; sadece ana fikirlerin anlaşılmasını ölçmek için oluşturulmuş bir anlama testi, grafiksel sürümü içeren metni üstün olarak gösterebilmektedir.…”

Readability of Patient Education Texts Presented on the Internet in the Field of Anesthesiology

“…Her iki anestezi türü için ortalama okunabilirlik aralığı "zor" olarak bulundu. Bezirci-Yılmaz okunabilirlik formülü ile yapılan hesaplamada, genel anestezi için 15,0 (12,(7)(8)(9)(10)(11)(12)(13)(14)(15)9), spinal ve epidural anestezi için 12,5 (11,3-14,0) değerleri bulundu (p<0,02). Bu formül ile her iki anestezi türü için hazırlanmış olan metinlerin ülkemizdeki eğitim sistemine göre "lisans düzeyinde" eğitim gerektirdiği saptandı.…”