Predictors of comprehension during surgical informed consent

Area of Science:

• Medical Informatics
• Patient Safety
• Surgical Education

Background:

• Patient comprehension of surgical informed consent is a persistent challenge.
• This study analyzes factors influencing understanding from a randomized trial on improving informed consent.

Purpose of the Study:

• To identify independent factors associated with improved patient comprehension during surgical informed consent.
• To evaluate the impact of a "repeat back" method and consent duration on understanding.

Main Methods:

• 575 patients undergoing elective surgery at VA medical centers were randomized to "repeat back" (RB) or standard computerized informed consent (iMedConsent).
• Patient comprehension was assessed post-discussion using questionnaires.
• Multiple linear regression identified factors associated with improved comprehension, including consent time.

Main Results:

• Factors associated with improved comprehension included race, ethnicity, age, operation type, RB assignment, and total consent time.
• Patient comprehension was highest when informed consent discussions lasted 15-30 minutes.
• The positive effect of RB on comprehension was less pronounced when consent time was included in the analysis.

Conclusions:

• Patient comprehension may be limited by factors such as ethnicity and education, potentially indicating language difficulties.
• Total informed consent time emerged as the strongest predictor of patient comprehension.
• Allocating sufficient time and utilizing tools like RB can enhance patient understanding in informed consent processes.