title: Informed consent in otologic surgery: prospective randomized study comparing risk recall with an illustrated handout and a nonillustrated handout.
abstract: OBJECTIVE
  Following consent, do pictures in a handout improve patients' recall of otologic surgical risks?
  
  
  METHODS
  Prospective, randomized trial in a tertiary care centre.
  
  
  METHODS
  Patients undergoing otologic surgery were consented with a standardized checklist of risks by two surgeons. They were randomized (stratified by educational level) to receive either a pure text or a text and pictures handout outlining the risks of surgery. A telephone interview tested recall at a mean of 19 days. Twenty-six patients were resampled at 1 year.
  
  
  METHODS
  Recall was analyzed with respect to type of handout, age, sex, and level of education. A subset of 31 patients was analyzed for the effects of which surgeon consented, previous otologic surgery, and actually reading the handout.
  
  
  RESULTS
  Fifty-one patients completed the study. The overall risk recall was 43%, with 45% in the pictorial group and 42% in the pure text group (p = .84). The illustrated handout did not improve the recall of any individual surgical risk either. Higher education improved risk recall from 36 to 54% (p = .009). Age, consenting surgeon, previous otologic surgery, and even reading the handout did not improve risk recall. A subgroup of 26 patients was followed up 1 year later, and their recall fell from 41 to 35%. The illustrated handout did not improve long-term recall (p = .674).
  
  
  CONCLUSIONS
  Pictorial cues do not improve recall of surgical risks, but education level does.
authors.affiliation: Division of Otolaryngology, Department of Surgery, Dalhousie University, Halifax, NS, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Henry
authors.forename: Timothy
authors.initials: T
authors.lastname: Brown
authors.forename: Clark
authors.initials: C
authors.lastname: Bartlett
authors.forename: Emad
authors.initials: E
authors.lastname: Massoud
authors.forename: Manohar
authors.initials: M
authors.lastname: Bance
mesh_terms: D000328:Adult; D032882:Comprehension; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence / Q000523:psychology*; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008488:Medical Illustration; D011939:Mental Recall; D008875:Middle Aged; D009998:Ossicular Prosthesis; D010174:Pamphlets; D010353:Patient Education as Topic / Q000331:legislation & jurisprudence / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D012153:Retention, Psychology; D013201:Stapes Surgery; D014433:Tympanoplasty