title: Improving comprehension of informed consent.
abstract: OBJECTIVE
  To explore the way the doctor-patient communication process may be improved by adopting the patients' conversational style in the development of written materials for surgical patients.
  
  
  METHODS
  Written information prepared by doctors, specialists in abdominal surgery, was tested for comprehension on patients undergoing cholecystectomy, using the standard Cloze test procedure. At the same time, the patients were asked to describe in their own words all they knew about their illness and the treatment. The collected 150 patient narratives were analyzed, and a typical narrative for each educational level was selected based on average SMOG score, word count and sentence length. The patient-worded information was then tested for comprehension on new patients, selected from primary health care, using the same Cloze procedure as with doctor-developed information. Patient profile of best lay communicators was defined using also sociodemographic characteristics, and reported information seeking and decision making preferences.
  
  
  RESULTS
  Only 50% of patients completed Cloze test, of which over 40% showed poor comprehension. Analysis of transcribed narratives collected from 150 patients showed increasing complexity of style by educational level (average SMOG score 7, 8, and 9; sentence length 11, 13, and 15 words; for low, medium, and high educational level, respectively). Cloze tests based on typical narratives, and tested on primary care patients, indicated to the style best understood by all. Dominant characteristics of patients producing a narrative of similar style to the best-understood narrative were observed: medium educational level, women over 60, urban workers, interviewed after surgery, informed by specialist at ultrasound, knowledge about illness from 1 to 10 years, learned most about illness from lay people, those who wanted more information in both oral and written form, and preferred active role in decision making.
  
  
  CONCLUSIONS
  Analysis of patient profiles with typical narratives that were best understood by other patients shows where to look for lay experts in doctor-patient communication.
  
  
  CONCLUSIONS
  Obtained findings indicate to the importance of patient participation in developing informed consent information, and to the possible method for improving comprehension of educational patient materials in general.
authors.affiliation: Department of Educational Technology, Andrija Stampar School of Public Health, Medical School, University of Zagreb, Rockefellerova 4, HR-10000 Zagreb, Croatia. skusec@snz.hr
authors.forename: Sanja
authors.initials: S
authors.lastname: Kusec
authors.forename: Stipe
authors.initials: S
authors.lastname: Oresković
authors.forename: Mate
authors.initials: M
authors.lastname: Skegro
authors.forename: Dragan
authors.initials: D
authors.lastname: Korolija
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Busić
authors.forename: Matija
authors.initials: M
authors.lastname: Horzić
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D017081:Cholecystectomy, Laparoscopic / Q000193:education / Q000523:psychology; D003142:Communication; D032882:Comprehension; D017523:Croatia; D003657:Decision Making; D004522:Educational Status; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007258:Informed Consent / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D033262:Narration; D010353:Patient Education as Topic / Q000592:standards*; D010817:Physician-Patient Relations; D011320:Primary Health Care; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013664:Teaching Materials / Q000592:standards; D014825:Vocabulary