Risk Management

Plain Language Concepts in Consent Discussions 

Anne M. Menke, RN, PhD, OMIC Risk Manager

The analysis of informed consent claims presented in the lead article indicates that patients often don’t understand the planned surgery. How can busy eye surgeons and their staff better explain the risks of treatment while staying on schedule? How can they know which patients need additional guidance or have misinterpreted what they have been told? Health literacy experts suggest that the use of “plain language” can help. This article will introduce this idea and explore ways it may be used to communicate more effectively. It will also discuss why changes to the informed consent process need to be made with care.

Q What exactly is “plain language”?

A The term is often used to measure the understandability of written material but applies to speaking as well. A document written in plain language allows people to find what they need, understand what they find, and act appropriately on that understanding.1

Q Are there guidelines for speaking and writing in plain language?

A Yes, there are a number of key principles, such as organizing material so the most important behavioral or action points come first and breaking complex information into understandable portions with one idea per sentence. One simple change you can make to enhance the clarity of messages is to use the active voice to make clear what action needs to be taken and by whom. Instead of “The drops should be used twice a day,” say “You need to put the drops into your eye twice a day.” Another tool is to use lists to make points: “You need to use three different eye drops after your surgery. The first one with the green label treats infection….” Employ “living room” words that patients already know to explain medical terms and include examples and analogies. For instance, “Eyes are usually round like a basketball. Yours is shaped like a football. This shape makes your vision blurry and is called astigmatism.”

Q I appreciate that anxious patients may have a hard time understanding the information I present. What else can I do to help?

A Start by stating the purpose of important parts of your discussion. “We know you have a cataract and that it needs to be removed. Now I need to decide what type of intraocular lens to put in your eye. To do that, I need to ask you some questions about how you use your eyes and what your goal is for the surgery.” Clarifying the key point is especially helpful for patients with complex conditions or those at higher risk. “You need this surgery to treat the hole in your retina. But your vision is already limited. I want to explain how the normal risks of this operation could cause extra problems for you.”

Q How can my staff and I tell if a patient needs additional guidance or has misinterpreted what we said?

A Communication experts suggest using a technique called “teach back” in which patients are asked to restate information in their own words. Suppose you have just finished recommending a combined cataract and glaucoma procedure. Say to your patient, “I want to make sure that I have explained why you need two different surgeries. Please tell me the two problems with your eyes that I am trying to help.” Use the same approach to clarify the goals of the surgery. “I want to make sure that I explained what vision you can expect with this type of lens. Please tell me when you might need to wear glasses.” Invite input from patients who do not seem to be actively engaged in the conversation. When doing so, avoid questions with yes and no answers (“Do you have any questions about your corneal transplant?”). Instead, you and your staff should encourage patients by asking open-ended questions: “We’ve presented a lot of information and may not have explained everything clearly. What questions do you have for me?”

Q How much information should we provide to minimize claims of lack of informed consent?

A Plain language experts feel patients are sometimes given too much information and recommend thinking of “need to know” instead of “good to know.” While this advice makes sense for clear communication, it may be problematic in the legal context of informed consent discussions. The informed consent process and forms serve a dual purpose: to inform the patient and to defend the physician against allegations of lack of informed consent. Physicians who shorten their forms and discussions too much may later be sued for failure to address certain issues. OMIC is actively exploring these issues with the help of plain language and legal consultants. We want to proceed carefully so both patients and physicians are well-served. For now, try incorporating some of these clear language principles into your conversations with patients.

1. “Plain Language: A Promising Strategy for Clearly Communicating Health Information and Improving Health Literacy.” http://www.health.gov/communication/literacy/plainlanguage/PlainLanguage.htm.

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