Informed consent in primary dental care: patients' understanding and satisfaction with the consent process

The purpose of the consent process is to give patients enough information to allow them to make an informed decision and preserve their autonomy. The patient's satisfaction and also their understanding of the consent process are audited only rarely and reports of such audits in dental practice are sparse. Reports from other specialties indicate that patients' understanding of the process is incomplete and often incorrect. We set about to perform such an audit to assess both our patients' satisfaction and their understanding of the consent process itself.

A prospective questionnaire study of adults with capacity.

Primary care dental practice.

A two-part questionnaire was designed, based on a questionnaire used for a similar purpose in paediatric surgery; the first part assessed the patient's opinion and satisfaction with the consent obtained by their dental professional and the second part assessed their understanding of the consent process in general and the legal issues around it.

Part 1 - satisfaction with the consent process. Patients reported high level of satisfaction with the consent process at the practice (near 100% in major factors analysed). Part 2 - Understanding of the consent process. Significant misconceptions were identified: 60% thought that the form was for the protection of the dentist/hospital and 10-16% thought that by signing a consent form they relinquish their rights. A high level of patients' uncertainty (19-27%) was also evident for several of the questions.

Although this study shows a very high level of patient satisfaction with the consent process at our dental practice, it also demonstrates very significant deficiencies in the patients' understanding of the consent process itself. This study corroborates the findings of other investigators in different medical disciplines and calls into question the adequacy of the current consent procedures as many patients are still unaware of the legal implications of consent; the majority of patients still do not recognise that the consent process should primarily be serving their interests by allowing them to express their autonomous choice pertaining to their treatment. Education will help reduce this discrepancy and promote a change from the past 'paternalistic' to the current 'informative, patient-centred' model of care.