Readability Analysis of Otolaryngology Consent Documents on the iMed Consent Platform

The American Medical Association (AMA) and National Institutes of Health (NIH) recommend all patient information and consent materials be provided at the fourth- to sixth-grade level. The iMed Consent platform is used nationally by the Veterans Health Administration and private hospitals. We aimed to assess the readability of otolaryngology consents at the West Los Angeles Veterans Affairs (WLA-VA) hospital to determine whether they conform with AMA/NIH guidelines.

A readability analysis of 27 otolaryngology iMed consent documents was performed. The main outcome measure was the Flesch-Kincaid Grade Level (FKGL). The setting of the study was an otolaryngology clinic at a major VA hospital. All consents used in the WLA-VA otolaryngology clinic for the month of October 2018 were analyzed using readability metrics. These included the Flesch Reading Ease (FRE) score, the FKGL, the Gunning Fog Index (GFI), Simple Measure of Gobbledygook (SMOG), and Coleman-Liau Index (CLI).

The following means of all consents were calculated for each of the readability metrics: FRE 56.3, FKGL 8.3, GFI 14.5, SMOG 11.3, and CLI 11.2. The standardized anesthesia and blood consent were analyzed separately with the following scores: FRE 45.1, FKGL 11.7, GFI 15.5, SMOG 14.6, and CLI 12.6. The average FKGL of the consents was found to be significantly above the sixth-grade level (P: .0013).

The average grade level of the otolaryngology iMed consents reviewed was at a reading level above the AMA/NIH recommendations. This objective measure should be taken into consideration when revising the iMed system and in the creation of future standardized consents. Readability analysis does not take into consideration the significant variance that exists as part of the verbal consent process that takes place between patient and provider.