Many patients may not understand consent forms
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《英国医生杂志》
EDITOR—McKinney et al highlight an important issue—namely, the difficulty of obtaining truly informed consent.1 This is a process that most surgeons engage in every day. The current requirement for informed consent is backed by a written record of the consent process in the form of a standard consent form that has been distributed by the Department of Health.2
Thousands of these forms are signed daily, but do we as doctors ever stop to consider how much of the form is read by patients and for those who do read it, how much of it is understood? Standard readability measurements can be used to assess readability, the Flesch readability ease score being one of the most validated. A document scoring 65 or above is considered to be readable for most adults. I found that the score for the entire text of the standard UK consent form is 45.1 and that the "Statement of patient" section, which details important patient concessions, is not much better at 48.9. These scores correspond to a "difficult college" level of literacy to understand the document.
The Office for National Statistics published data in 1996 that indicate that nearly half of the UK adult population between the ages of 16 and 65 have levels of literacy low enough to significantly interfere with daily work tasks.3 As clinicians and health communicators, we must either shoulder the additional burden of translating the current consent form into understandable language for a proportion of our patients or we should consider using another, more patient friendly form.
David D Pothier, specialist registrar in otolaryngology
Gloucestershire Royal Hospital, Gloucester GL1 3NN email@davepothier.com
Competing interests: None declared.
References
McKinney PA, Jones S, Parslow R, Davey N, Darowski M, Chaudhry B, et al. A feasibility study of signed consent for the collection of patient identifiable information for a national paediatric clinical audit database. BMJ 2005;330: 877-9. (16 April.)
Department of Health. Consent key documents. www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/Consent/ ConsentGeneralInformation/fs/en (accessed 28 Apr 2005).
Office for National Statistics. UK: adult literacy survey: literacy level of adults by gender and age. www.statistics.gov.uk/statbase/expodata/spreadsheets/d5047.xls. 1996. (accessed 19 Apr 2005).
Thousands of these forms are signed daily, but do we as doctors ever stop to consider how much of the form is read by patients and for those who do read it, how much of it is understood? Standard readability measurements can be used to assess readability, the Flesch readability ease score being one of the most validated. A document scoring 65 or above is considered to be readable for most adults. I found that the score for the entire text of the standard UK consent form is 45.1 and that the "Statement of patient" section, which details important patient concessions, is not much better at 48.9. These scores correspond to a "difficult college" level of literacy to understand the document.
The Office for National Statistics published data in 1996 that indicate that nearly half of the UK adult population between the ages of 16 and 65 have levels of literacy low enough to significantly interfere with daily work tasks.3 As clinicians and health communicators, we must either shoulder the additional burden of translating the current consent form into understandable language for a proportion of our patients or we should consider using another, more patient friendly form.
David D Pothier, specialist registrar in otolaryngology
Gloucestershire Royal Hospital, Gloucester GL1 3NN email@davepothier.com
Competing interests: None declared.
References
McKinney PA, Jones S, Parslow R, Davey N, Darowski M, Chaudhry B, et al. A feasibility study of signed consent for the collection of patient identifiable information for a national paediatric clinical audit database. BMJ 2005;330: 877-9. (16 April.)
Department of Health. Consent key documents. www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/Consent/ ConsentGeneralInformation/fs/en (accessed 28 Apr 2005).
Office for National Statistics. UK: adult literacy survey: literacy level of adults by gender and age. www.statistics.gov.uk/statbase/expodata/spreadsheets/d5047.xls. 1996. (accessed 19 Apr 2005).