Predictors of Comprehension during Surgical Informed Consent

被引：98

作者：

Fink, Aaron S. ^{[1
,2
]}

Prochazka, Allan V. ^{[3
,4
]}

Henderson, William G. ^{[4
]}

Bartenfeld, Debra ^{[1
]}

Nyirenda, Carsie ^{[4
]}

Webb, Alexandra ^{[1
,2
]}

Berger, David H. ^{[5
,6
]}

Itani, Kamal ^{[7
,8
,9
]}

Whitehill, Thomas ^{[10
,11
]}

Edwards, James ^{[12
,13
]}

Wilson, Mark ^{[14
,15
]}

Karsonovich, Cynthia ^{[16
,17
]}

Parmelee, Patricia ^{[18
]}

机构：

[1] VAMC Atlanta, Decatur, GA 30033 USA

[2] Emory Univ, Sch Med, Dept Surg, Atlanta, GA 30322 USA

[3] Denver VAMC, Denver, CO USA

[4] Univ Colorado, Hlth Outcomes Program, Denver, CO 80202 USA

[5] Baylor Coll Med, Michael DeBakey VAMC, Houston, TX 77030 USA

[6] Baylor Coll Med, Michael DeBakey Dept Surg, Houston, TX 77030 USA

[7] Boston Univ, Boston VAMC, Boston, MA 02215 USA

[8] Boston Univ, Dept Surg, Boston, MA 02215 USA

[9] Harvard Univ, Sch Med, Boston, MA USA

[10] Univ Colorado, Denver VAMC, Denver, CO 80202 USA

[11] Univ Colorado, Dept Surg, Denver, CO 80202 USA

[12] Oregon Hlth & Sci Univ, Portland VAMC, Portland, OR 97201 USA

[13] Oregon Hlth & Sci Univ, Dept Surg, Portland, OR 97201 USA

[14] Univ Pittsburgh, Med Ctr, Pittsburgh VAMC, Pittsburgh, PA USA

[15] Univ Pittsburgh, Med Ctr, Dept Surg, Pittsburgh, PA USA

[16] Univ S Florida, Tampa VAMC, Tampa, FL USA

[17] Univ S Florida, Dept Surg, Tampa, FL USA

[18] Univ Alabama, Dept Psychol, Tuscaloosa, AL 35487 USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS | 2010年 / 210卷 / 06期

关键词：

LITERACY SKILLS; HEALTH LITERACY; PATIENT RECALL; SHORT-FORM; INFORMATION; ANXIETY; TRIALS; INTERVENTIONS; COMMUNICATION; VOLUNTEERS;

D O I：

10.1016/j.jamcollsurg.2010.02.049

中图分类号：

R61 [外科手术学];

学科分类号：

100210 [外科学];

摘要：

BACKGROUND: Patient comprehension during surgical informed consent remains problematic. Using data from our randomized trial of methods to improve informed consent comprehension, we performed an additional analysis to define independent factors associated with improved patient understanding. STUDY DESIGN: Patients scheduled for 1 of 4 elective operations (total hip arthroplasty [n = 137], carotid endarterectomy [n = 178], laparoscopic cholecystectomy [n = 179], or radical prostatectomy [n = 81]) at 7 Department of Veterans Affairs (VA) medical centers were enrolled. All informed consent discussions were performed using iMedConsent (Dialog Medical), the VA's computerized informed consent platform. Using a unique module within iMedConsent, we randomized patients to repeat back (RB), requiring correct reiteration of procedure-specific facts, or standard (STD) iMedConsent. Patient comprehension was tested after the informed consent discussion using procedure-specific questionnaires. Time spent completing the informed consent process was measured using time stamps within iMedConsent. Multiple linear regression identified factors independently associated with improved comprehension. RESULTS: We enrolled 575 patients (276 RB, 299 standard); 93% were male, 74% were Caucasian, and 89% had at least a high school education. Independent factors associated with improved comprehension included race (p < 0.01), ethnicity (p < 0.05), age (p < 0.02), operation type (p < 0.01), group assignment (+/- RB; p < 0.05), and total consent time (p < 0.0001). Patient comprehension was maximized when informed consent took between 15 and 30 minutes. RB's positive impact on patient comprehension was weaker in the analysis including consent time. CONCLUSIONS: Comprehension during informed consent discussions may be limited in individuals with potential language difficulty due to ethnicity or education. Total consent time was the strongest predictor of patient comprehension. Affording adequate time for informed consent discussions and using informed consent adjuncts such as RB may enhance comprehension in such individuals. (J Am Coll Surg 2010;210:919-926. (C) 2010 by the American College of Surgeons)

引用

页码：919 / 926

页数：8

共 48 条

[1]

Telephone-based nursing intervention improves the effectiveness of the informed consent process in cancer clinical trials [J].