Standardized Consent: The Effect of Information Sheets on Information Retention

Informed consent embodies the ethical principle of autonomy of the surgical patient. Effective communication is essential to this decision-making process. Variability in consent can lead to confusion among patients and can expose the surgeon to risk in an increasingly litigious environment.

This study aimed to evaluate the use of a standardized consenting process and assess the pattern of information recall following provision of patient information sheets.

One hundred orthopedic clinic patients were randomly selected to participate in this prospective audit. Mean age was 41 years. Each participant was consented to undergo wrist manipulation under anaesthesia and K-wiring using a standardized British Orthopaedic Association consent form. A 22-item questionnaire was completed based on the information provided. Half of the cohort received additional printed take-home material. Each questionnaire was repeated 1 day later to determine which aspects of consent were best retained.

Baseline scores were low on initial questioning for each section. There was a significant decrease in information retained over 24-hour interval (mean, 8.94 versus 7.98, P ≤ 0.000). Where standardized forms were provided, individual baseline scores rose significantly 24 hours after initial questioning. In particular, arthritis, neurovascular injury, and infection were more likely to be remembered with provision of written information (P = 0.01). Significantly lower scores were seen in those who had not received written information (mean, 9.542 versus 6.449; P ≤ 0.00).

Consent remains challenging even with a standardized process. Information retention improves significantly with the use of information sheets. We advocate the use of standard consent and provision of patient information sheets for commonly performed procedures.