421 Interventions effective for promoting informed consent

May 08, 2014

PEARLS 421, February, 2014, written by Brian R McAvoy

Clinical question
How effective are interventions to promote informed consent for patients undergoing surgical and other invasive health care treatments and procedures?

Bottom line
Meta-analyses showed statistically-significant improvements in knowledge when measured immediately after interventions, shortly afterwards (between 24 hours and 14 days), and at a later date (15 days or more). Satisfaction with decision making was increased, decisional conflict was reduced, and consultation length was increased. No statistically-significant differences were found for generalised anxiety, and either anxiety or satisfaction with the consent process. Interventions used various designs and formats but the main data for results were from studies using written materials, audio-visual materials and decision aids. Some interventions were delivered before admission to hospital for the procedure, while others were delivered on admission.

There were high levels of heterogeneity associated with many of the main analyses. Only one study attempted to measure the primary outcome, which was informed consent as a unified concept, but this study was at high risk of bias.

Research suggests that when informed consent is obtained, the information provided by health care professionals is often unclear or insufficient, leading to misunderstanding, a worse treatment response and even litigation. A number of interventions have been developed to improve the quality of information provided to patients, including written pamphlets, videos and websites.

Cochrane Systematic Review
Kinnersley P, et al. Interventions to promote informed consent for patients undergoing surgical and other invasive healthcare procedures. Cochrane Reviews, 2013, Issue 7. Art. No.: CD009445.DOI: 10.1002/14651858. CD009445.pub2. This review contains 65 studies involving 9,021 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.