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Basic information enhances informed consent for cataract surgery
Addition of simplified written content or an educational video helps patients grasp critical concepts and make informed decisions.
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Concise written material or an educational video, when combined with verbal presentation, maximized patients’ understanding of the benefits, risks and alternatives to cataract surgery, a study found.
Improved comprehension of critical information reinforces the informed consent process for patients, the authors said.
“We really have an obligation to our patients to explain these potential risks and benefits in terms that they can fully understand so they can make a well-informed decision as to whether or not they want to proceed,” Mary K. Daly, MD, chief of ophthalmology at Veterans Affairs Boston Healthcare System and corresponding study author, said in an interview.
“Cataract surgery is the most commonly performed eye operation in the United States,” Dr. Daly said. “Although complication rates are low, complications can sometimes lead to very poor outcomes. These complications account for approximately one-third of the malpractice claims against ophthalmologists.”
The authors noted that because malpractice is often difficult to prove, inadequate informed consent is implicated in more than 90% of ophthalmic malpractice cases.
“Optimization and documented understanding of informed consent are a win-win for the patient and the provider. We best serve our patients when we actively educate and involve them in that process,” Dr. Daly said.
The study was published in the Journal of Cataract and Refractive Surgery.
Patients and protocols
The prospective, randomized study included 100 patients being considered for cataract surgery at the Veterans Affairs Boston Healthcare System, an academic tertiary referral center. All patients were military veterans and were randomized to four groups.
The first group received conventional verbal content. The second group received conventional verbal information combined with a brochure written on a second grade reading level. The third group received verbal information with a brochure written on an eighth grade reading level. The fourth group received verbal content combined with an informational DVD from the American Academy of Ophthalmology. Each group included 25 patients.
Mean patient age was 73 years in the first and second groups, 72 years in the third group and 77 years in the fourth group.
All four groups’ educational levels ranged from some high school to some college. Scores ranged from 0.5 (no high school) to 4 (advanced degree). Mean educational level was 1.32 in the first group, 1.9 in the second group, 1.12 in the third group and 1.5 in the fourth group.
After undergoing informed consent, patients completed a 12-part multiple-choice questionnaire on the benefits, risks and treatment alternatives to cataract surgery. Scores were based on the number of correct responses.
Results and findings
Study results showed mean scores of 7.68 in the first group, 10.8 in the second group, 9.08 in the third group and 10.56 in the fourth group. Scores in the second group and fourth group were significantly higher than those in the first or third groups.
“This is very significant because a lot of eye centers give out pamphlets and information sheets that are at the eighth grade reading level, while our study showed that concise, simpler forms enhance understanding when compared to higher-grade reading sheets,” Dr. Daly said.
The data showed no significant correlation between previous cataract surgery or education level and patient understanding of the informed consent process.
“We didn’t look at what their understanding was later, when they came back for the surgery,” Dr. Daly said. “For future study, it would be helpful to examine patient recall not only on the day of the initial informed consent process, but again on the day of surgery.”
The study demonstrated that patients who, in addition to getting the conventional verbal information, were given a concise information sheet or watched the AAO video performed better on questionnaires than those who received conventional verbal information alone or combined with higher reading level information sheets.
“It would be interesting to see if there was added benefit to offering patients both concise information sheet at a lower-grade reading level and the AAO video along with the conventional verbal presentation of risks/benefits of cataract surgery,” Dr. Daly said. – by Matt Hasson
Reference:
- Shukla AN, Daly MK, Legutko P. Informed consent for cataract surgery: Patient understanding of verbal, written and videotaped information. J Cataract Refract Surg. 2012;38(1):80-84.
For more information:
- Mary K. Daly, MD, can be reached at Department of Ophthalmology, Veterans Affairs Boston Health-care System, Office 8C-29, 150 South Huntington, Boston, MA 02130; email: mary.daly2@va.gov.
- Disclosure: Dr. Daly has no relevant financial disclosures.