Patients' recollection and understanding of informed consent: a literature review

To explore patients' recollection and understanding of the proposed medical procedures for which they have consented.

Six databases were searched from January 1995 to March 2013 for articles using the MeSH terms 'informed consent', 'patients' and 'comprehension', and the free text search term 'patient understanding'. This search identified 354 articles. Once duplicates (n = 213) were removed, the remaining 141 articles were screened, resulting in 13 high-quality studies that met the inclusion criteria.

When asked to reflect on the consenting process, between 21% and 86% of patients were able to recall the potential risks and complications of their medical procedure. The degree of understanding of the consenting process decreased with age. Some patients were of the opinion that the primary purpose of the consent procedure was to protect hospitals and doctors.

Level of education, literacy and language competency, combined with physicians' ability to effectively explain the medical procedure and the inherent risks and complications, were important determinants of patients' capacity to provide fully informed consent. The use of education materials delivered in written form or embedded in an interactive multimedia process led to improvements in patients' understanding of the implications of surgery.

This review found that patients' recollection and understanding of the medical procedure, risks and complications is often low, particularly among older individuals. The use of interactive multimedia and written material that are easy-to-read and comprehend, and prepared for individual patients has been shown to increase patient awareness, recollection and understanding of the consenting procedure.