title: Role of cognitive function in assessing informed consent for endoscopy.
abstract: BACKGROUND
  Patient understanding of the consent process is often suboptimal and the reasons for this are poorly understood. In particular the role of cognitive function in assessing the level of understanding of consent has not been evaluated.
  
  
  OBJECTIVE
  This study aims to assess the level of patient understanding of the informed consent process and the role of cognitive function in those with low levels of understanding.
  
  
  METHODS
  The study was prospective, interviewing patients immediately after they had given consent but before undergoing their procedure. Understanding of the reason for the procedure, the risks attendant upon it, details of the procedure itself and post procedure care was scored with the total representing overall level of understanding. A mini mental state examination (MMSE) was then performed with the score recorded.
  
  
  RESULTS
  100 patients were interviewed. A low level of understanding was shown in 36%. Ninety two patients had a MMSE score greater than 24. All patients with a high level of understanding had MMSE scores greater then 24 compared with 78% of those with a low level of understanding. All patients (n = 8) who displayed a MMSE score less than 24 had a low level of understanding. Men displayed poorer levels of understanding than women. A subnormal MMSE only identified 22% of those with low levels of understanding.
  
  
  CONCLUSIONS
  Understanding of the consent process is suboptimal. Adequate cognitive function does not predict a high level of understanding of the informed consent process while cognitive impairment precludes it. It is evident, however that factors other than cognitive dysfunction are at play when attempting to explain low levels of understanding.
authors.affiliation: Gastroenterology Unit, Department of Medicine, Prince Philip Hospital, Llanelli, Wales.
authors.forename: A D
authors.initials: AD
authors.lastname: Yeoman
authors.forename: M J
authors.initials: MJ
authors.lastname: Dew
authors.forename: L
authors.initials: L
authors.lastname: Das
authors.forename: S
authors.initials: S
authors.lastname: Rajapaksa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D003072:Cognition Disorders / Q000523:psychology*; D032882:Comprehension; D004724:Endoscopy / Q000941:ethics*; D005260:Female; D006801:Humans; D007258:Informed Consent; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D011446:Prospective Studies; D011581:Psychological Tests; D006113:United Kingdom