The influence of process and patient factors on the recall of consent information in mentally competent patients undergoing surgery for neck of femur fractures

Abstract

INTRODUCTIONInformed consent is an ethical and legal prerequisite for major surgical procedures. Recent literature has identified ‘poor consent’ as a major cause of litigation in trauma cases. We aimed to investigate the patient and process factors that influence consent information recall in mentally competent patients (abbreviated mental test score [AMTS] ≥6) presenting with neck of femur (NOF) fractures.METHODSA prospective study was conducted at a tertiary unit. Fifty NOF patients (cases) and fifty total hip replacement (THR) patients (controls) were assessed for process factors (adequacy and validity of consent) as well as patient factors (comprehension and retention) using consent forms and structured interview proformas.RESULTSThe two groups were matched for ASA (American Society of Anesthesiologists)grade and AMTS. The consent forms were adequate in both groups but scored poorly for validity in the NOF group. Only 26% of NOF patients remembered correctly what surgery they had while only 48% recalled the risks and benefits of the procedure. These results were significantly poorer than in THR patients (p=0.0001).CONCLUSIONSThis study confirms that NOF patients are poor at remembering the information conveyed to them at the time of consent when compared with THR patients despite being intellectually and physiologically matched. We suggest using pre-printed consent forms (process factors), information sheets and visual aids (patient factors) to improve retention and recall.

How to effectively obtain informed consent in trauma patients: a systematic review

“…The remaining eight studies on informed consent in adult trauma patients were included in the review for narrative synthesis [40–47] (Table 2). One study was conducted in the United States [40], one in Turkey [42], one in Korea [45], one in Taiwan [46], three in the United Kingdom [41, 43, 44], and one in Ireland [47]. All studies were conducted to evaluate the informed consent process in adult trauma patients.…”

Awareness of the patients' rights by subjects on admission to a tertiary university hospital in Poland

“…8 Additional data in given regarding patients with intellectual disabilities in whom providing information about treatment in written form or with simple visualization of the problem is helpful and increases the effectiveness of consent. 15,16 Also, the use of more clear fonts and adequate spacing help the reader understand the text. 17 A very important aspect of patients' rights described Hocker et al 18 who showed that 31.4% of deaf patients were not informed about their rights and younger age and lower level of education had impact on the results.…”

Informed consent for clinical treatment in low-income setting: evaluating the relationship between satisfying consent and extent of recall of consent information

“…However, their questions used dichotomous responses unlike ours that were non-leading open-ended in structure. In another study, only 26% of the test group remembered correctly the surgery undergone the day after the surgery [ 22 ]. Such a very low recall might not be unconnected to the timing of the administration of the test questions.…”