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A small UK study has suggested that factors other than adequate cognitive function determine patients' understanding in the process of informed consent. Just how to obtain truly informed consent remains elusive.
The prospective survey of consecutive outpatients undergoing endoscopy showed that all those with a high degree of understanding of the procedure had normal cognitive function (Mini Mental State Examination score >24), but so did 78% of those with low understanding, leaving just 22% with low understanding and low cognitive function. Conversely, half of those patients with no understanding and 83% with low understanding had normal cognitive function. Among the 100 patients studied, 36 had low understanding and eight of these had subnormal cognitive function. Between 92 and 98 patients reported having had written or oral information about the procedure. The mean age of the cohort was 56 (median 52) years.
All patients were interviewed before endoscopy, immediately after giving consent, to gauge their understanding of the reasons for the procedure, its risks, what the procedure entailed, and aftercare. All outpatients are sent a written leaflet on the procedure, based on current national guidelines, before attending for endoscopy.
Informed consent is often difficult to satisfy fully because of patients' poor understanding. The researchers wondered whether cognitive function might be implicated, having found earlier that up to a third of outpatients had poor understanding and recall of consent they had just given. The role of cognitive function in informed consent has not been studied in a clinical setting.
Yeoman AD, et al.Postgraduate Medical Journal 2006;82:65–69.
Please visit the Quality and Safety in Health Care website [www. qshc.com] for a link to the full text of this article.