Hospitals look to improve informed consent process

New technology, simpler forms and better dialogue are seen as key to ensuring patient comprehension and preventing harm.

By Kevin B. O'Reilly, AMNews staff. Nov. 19, 2007.

Toni Cordell's surgery would be "an easy repair," her doctor said. Embarrassed at being a slow reader, she signed the informed-consent papers she was given without understanding them.

She said no one, including her doctor, explained the procedure in detail beforehand or uttered the word "hysterectomy." Cordell didn't discover the nature of her operation until months after surgery when an office nurse inquired about her recovery.

"How are you doing," the nurse asked, "since your hysterectomy?"

In the decades since the surgery, Cordell, a San Francisco native, has become a proficient reader and an outspoken literacy advocate. But back then, she was too ashamed to ask questions that would reveal she had trouble comprehending the forms designed to legally prove she consented to the procedure.

Cordell's story of being bewildered by medical-legal jargon is not unique. According to a 2005 National Quality Forum report, between 60% and 70% of patients do not read or understand informed-consent documents and nearly half cannot recall the exact nature of the operation to be performed.

Now a growing number of hospitals and physicians are moving to redesign informed-consent protocols. They are using new computer technology and education techniques to improve safety and ensure that patients understand a surgery's risks and benefits. Informed consent is a process, they say, not a piece of paper.

The changes come on the heels of guidelines issued in April by the Centers for Medicare & Medicaid Services that detailed what elements hospitals should include in their consent forms. Meanwhile, the Joint Commission and the National Quality Forum have called on hospitals to make forms more reader friendly, engage patients in a dialogue about procedures and use the teach-back method to ensure understanding.