Orthodontic informed consent considering information load and serial position effect.
BACKGROUND
Previous research has demonstrated that current methods of informed consent are relatively ineffective as shown by poor recall and comprehension by adolescent patients and their parents. The purpose of this study was to determine whether adding a short videotape presentation reiterating the issues related to informed consent to a modified informed consent document that emphasizes a limited number of core and patient-specific custom "chunks" at the beginning of an informed consent presentation improved the recall and comprehension of the risks, benefits, and alternatives of orthodontic treatment. A second objective was to evaluate the current related data for recommendable practices.


METHODS
Seventy patient-parent pairs were randomly divided into 2 groups. The intervention group (group A) patients and parents together reviewed a customized slide show and a short videotape presentation describing the key risks of orthodontic treatment. Group B followed the same protocol without viewing the videotape. All patients and parents were interviewed independently by research assistants using an established measurement tool with open-ended questions. Interviews were transcribed and scored for the appropriateness of responses using a previously established codebook. Lastly, the patients and parents were given 2 reading literacy tests, 1 related to health and 1 with general content followed by the self-administered demographic and psychological state questionnaires.


RESULTS
There were no significant differences between the groups for sociodemographic variables. There were no significant differences between the groups for overall recall and comprehension; recall and comprehension for the domains of treatment, risk, and responsibility; and recall and comprehension for core, general, and custom items. The positional effects were limited in impact. When compared with previous studies, these data further demonstrate the benefit of improved readability and audiovisual supplementation with the addition of "chunking."


CONCLUSIONS
There is no benefit to adding a short video to the previously established improved readability and audiovisual supplementation. There is a significant benefit of improved readability and audiovisual slide supplementation with the addition of "chunking" over traditional informed consent methods in terms of patient improvement in overall comprehension, treatment recall, and treatment comprehension. The treatment domain is the most affected.
Private practice, DeLand, Fla.
Caroline E
CE
Pawlak
Professor and chair, Division of Orthodontics, College of Dentistry, Ohio State University, Columbus, Ohio. Electronic address: Fields.31@osu.edu.
Henry W
HW
Fields
Professor emeritus, Ohio State University, Columbus, Ohio.
F Michael
FM
Beck
Associate professor, Division of Orthodontics, College of Dentistry, Ohio State University, Columbus, Ohio.
Allen R
AR
Firestone
D000293:Adolescent; D000328:Adult; D001296:Audiovisual Aids; D002648:Child; D032882:Comprehension; D032962:Consent Forms; D004522:Educational Status; D005260:Female; D057220:Health Literacy; D006801:Humans; D007258:Informed Consent; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D009971:Orthodontics, Corrective; D010290:Parents / Q000193:education; D010347:Patient Care Planning; D010353:Patient Education as Topic; D018570:Risk Assessment; D012647:Self-Assessment; D014743:Videotape Recording; D064232:Visual Analog Scale